Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01971 | Date 25/04/2019 |
| Token No | SM/18-19/3369 25/04/2019 | Serial | 001 |
| Patient Name | Mr. SANTIMOY DEY | Contact No | 9477045309 |
| Address | 5A DEY STREET | Age | 67 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||