Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03629 | Date 16/12/2019 |
| Token No | SM/19-20/8229 03/01/2020 | Serial | 027 |
| Patient Name | Mr. SURAJ CHOWDHURY | Contact No | 9681620308 |
| Address | 7 DEY GHAT LANE | Age | 36 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||