Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 02140 | Date 30/05/2019 |
| Token No | SM/18-19/3852 30/05/2019 | Serial | 001 |
| Patient Name | Mr. SANTOSH DAS | Contact No | NOT GIVEN |
| Address | 57/A THAKURBATI ST | Age | 65 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||