Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02558 | Date 20/07/2019 |
| Token No | SM/18-19/5007 20/07/2019 | Serial | 017 |
| Patient Name | Mr. KAMAL BARIK | Contact No | 9857489636 |
| Address | 5 INDIA JUTE MILL | Age | 58 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||