Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01335 | Date 04/12/2018 |
| Token No | SM/18-19/2617 28/02/2019 | Serial | 001 |
| Patient Name | Mr. SK. SALAM | Contact No | NOT GIVEN |
| Address | 26 K.C BHATTACHARYA ST | Age | 54 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||