Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02761 | Date 07/08/2019 |
| Token No | SM/18-19/5505 07/08/2019 | Serial | 021 |
| Patient Name | Mr. SASHI BHUSAN MAHATO | Contact No | NOT GIVEN |
| Address | DEY STREET | Age | 40 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||