Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00200 | Date 17/08/2018 |
| Token No | SM/18-19/5001 20/07/2019 | Serial | 011 |
| Patient Name | Mr. BHOLANATH CHAKRABORTY | Contact No | 8017789968 |
| Address | SITALA TALA LANE, CHATRA | Age | 71 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||