Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00643 | Date 05/09/2018 |
| Token No | SM/18-19/820 05/09/2018 | Serial | 013 |
| Patient Name | Mr. AMARJIT DEY | Contact No | 9875440169 |
| Address | 5/2C DEY STREET | Age | 20 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||