Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01822 | Date 27/03/2019 |
| Token No | SM/18-19/2971 29/03/2019 | Serial | 019 |
| Patient Name | Mr. SK. BASIRUDDIN | Contact No | NOT GIVEN |
| Address | 13K.C. BHATTACHARYA LANE | Age | 58 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||