Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03126 | Date 26/09/2019 |
| Token No | SM/18-19/6714 26/09/2019 | Serial | 025 |
| Patient Name | Mr. SURAJIT DAS | Contact No | 9804791068 |
| Address | 9 PATUA PARA | Age | 24 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||