Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02638 | Date 29/07/2019 |
| Token No | SM/18-19/5208 29/07/2019 | Serial | 018 |
| Patient Name | Mr. RANJAN SHAH | Contact No | 9007095049 |
| Address | 18 A K C BHATTACHARJEE STREET | Age | 21 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||