Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 02767 | Date 07/08/2019 |
| Token No | SM/18-19/5512 07/08/2019 | Serial | 028 |
| Patient Name | Mr. ANANDA MOHON BISWAS | Contact No | 9051164054 |
| Address | 109 RISHI BANKIM SARANI | Age | 56 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||