Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01779 | Date 10/03/2019 |
| Token No | SM/18-19/2805 15/03/2019 | Serial | 006 |
| Patient Name | Mr. RAJA SAMAL | Contact No | 8240874989 |
| Address | 9 NO LINE SERAMPORE | Age | 23 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||