Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03181 | Date 14/10/2019 |
| Token No | SM/18-19/6959 17/10/2019 | Serial | 020 |
| Patient Name | Mr. ARPAN CHAKRABORTY | Contact No | 8697044053 |
| Address | 334/C/B VIVEKANANDA SARANI, SODEGOPE PARA | Age | 16 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||