Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03190 | Date 15/10/2019 |
| Token No | SM/18-19/6920 15/10/2019 | Serial | 012 |
| Patient Name | Mr. AVIJIT DAS | Contact No | 9239417311 |
| Address | 112 PATUA PARA | Age | 24 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||