Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03200 | Date 17/10/2019 |
| Token No | SM/18-19/6949 17/10/2019 | Serial | 010 |
| Patient Name | Mr. SUSANTA DE | Contact No | 9432246814 |
| Address | 4/A DEY STREET | Age | 52 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||