Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 01961 | Date 23/04/2019 |
| Token No | SM/18-19/3345 23/04/2019 | Serial | 016 |
| Patient Name | Mr. ASHOK DAS | Contact No | NOT GIVEN |
| Address | 15/A/2 PATUA PARA LANE | Age | 44 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||