Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01922 | Date 16/04/2019 |
| Token No | SM/18-19/3336 23/04/2019 | Serial | 007 |
| Patient Name | Mr. JIBON DEY | Contact No | NOT GIVEN |
| Address | 2 NO DEY STREET | Age | 66 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||