Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00619 | Date 21/08/2018 |
| Token No | SM/18-19/4144 14/06/2019 | Serial | 002 |
| Patient Name | Mr. BIJOY JANA | Contact No | |
| Address | Age | 49 Male | |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||