Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03040 | Date 13/09/2019 |
| Token No | SM/18-19/6424 13/09/2019 | Serial | 028 |
| Patient Name | Mr. UTTAM SHA | Contact No | 6290833779 |
| Address | 19 AKC BHATTACHARYA ST | Age | 47 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||