Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03229 | Date 18/10/2019 |
| Token No | SM/18-19/7011 18/10/2019 | Serial | 036 |
| Patient Name | Mr. BIBHU PADA SARKAR | Contact No | 7450043229 |
| Address | 2 NO DAKTAR BAGAN LANE | Age | 54 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||