Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 01947 | Date 22/04/2019 |
| Token No | SM/18-19/3309 22/04/2019 | Serial | 002 |
| Patient Name | Mr. AJIT KUMAR GHOSH | Contact No | 9836049025 |
| Address | 34/B BAISHNAB PARA 2ND LANE | Age | 61 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||