Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03406 | Date 16/11/2019 |
| Token No | SM/18-19/7458 16/11/2019 | Serial | 008 |
| Patient Name | Mr. DHARMNATH SHAW | Contact No | NOT GIVEN |
| Address | DEY GHAT LANE | Age | 60 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||