Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03147 | Date 30/09/2019 |
| Token No | SM/18-19/6806 30/09/2019 | Serial | 031 |
| Patient Name | Mr. SANKAR DAS | Contact No | 9143694170 |
| Address | 67A DHULI PARA LANE | Age | 60 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||