Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01571 | Date 15/01/2019 |
| Token No | SM/18-19/3463 30/04/2019 | Serial | 004 |
| Patient Name | Mr. PADMAN PRADHAN | Contact No | 9748992097 |
| Address | 45 N L BHATTACHARJEE STREET | Age | 40 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||