Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01743 | Date 05/03/2019 |
| Token No | SM/18-19/2676 05/03/2019 | Serial | 008 |
| Patient Name | Mr. SK SARU | Contact No | NOT GIVEN |
| Address | K.C BHATTACHARYA ST | Age | 21 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||