Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02628 | Date 26/07/2019 |
| Token No | SM/18-19/5174 26/07/2019 | Serial | 053 |
| Patient Name | Mr. RAJENDRA MAHATO | Contact No | 9748746423 |
| Address | 23 N L BHATTACHARJEE STREET | Age | 53 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||