Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02553 | Date 18/07/2019 |
| Token No | SM/18-19/4975 18/07/2019 | Serial | 001 |
| Patient Name | Mr. SK. SAJID ALI | Contact No | 9123777085 |
| Address | 9A K.C.BHATTACHARYA ST | Age | 23 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||