Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00958 | Date 25/09/2018 |
| Token No | SM/18-19/2436 14/02/2019 | Serial | 002 |
| Patient Name | Mr. RABINDRA NATH NANDI | Contact No | NOT GIVEN |
| Address | 92 DEY STREET | Age | 67 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||