Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03065 | Date 17/09/2019 |
| Token No | SM/19-20/7816 02/12/2019 | Serial | 021 |
| Patient Name | Mr. RABINDRA NATH DAS | Contact No | NOT GIVEN |
| Address | 19 PATUA PARA LANE | Age | 73 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||