Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01137 | Date 11/10/2018 |
| Token No | SM/18-19/2940 28/03/2019 | Serial | 020 |
| Patient Name | Mr. BIPOD TARAN BERA | Contact No | 9874360260 |
| Address | 12 JAGA MOHAN LAHIRI LANE( REFERRED FROM HAU 2) | Age | 54 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||