Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01705 | Date 21/02/2019 |
| Token No | SM/18-19/2556 21/02/2019 | Serial | 024 |
| Patient Name | Mr. PINTU SHA | Contact No | 7595883488 |
| Address | 79B DEY ST | Age | 22 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||