Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02555 | Date 18/07/2019 |
| Token No | SM/18-19/4977 18/07/2019 | Serial | 003 |
| Patient Name | Mr. AVIK NANDI | Contact No | NOT GIVEN |
| Address | DEY ST | Age | 50 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||