Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 00975 | Date 27/09/2018 |
| Token No | SM/18-19/3700 17/05/2019 | Serial | 004 |
| Patient Name | Mr. SRIKANTA GANGULY | Contact No | 8902387046 |
| Address | 15 LIBRARY LANE | Age | 53 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||