Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01287 | Date 16/11/2018 |
| Token No | SM/18-19/2804 15/03/2019 | Serial | 005 |
| Patient Name | Mr. GOUTAM BANERJEE | Contact No | NOT GIVEN |
| Address | THAKURBATI ST | Age | 64 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||