Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02578 | Date 01/07/2019 |
| Token No | SM/18-19/5031 01/07/2019 | Serial | 005 |
| Patient Name | Mr. MD MUSTAQUE | Contact No | not given |
| Address | NEAR BSNL OFFICE | Age | 69 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||