Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 02666 | Date 30/07/2019 |
| Token No | SM/18-19/5684 16/08/2019 | Serial | 052 |
| Patient Name | Mr. ARUP DAS | Contact No | NOT GIVEN |
| Address | 11 DEY BAGAN LANE | Age | 59 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||