Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00733 | Date 18/09/2018 |
| Token No | SM/18-19/5658 16/08/2019 | Serial | 026 |
| Patient Name | Mr. SANTOSH MONDOL | Contact No | 8334827354 |
| Address | 5, RUDRA RAM PANDIT LANE | Age | 80 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||