Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03690 | Date 06/01/2020 |
| Token No | SM/19-20/8265 06/01/2020 | Serial | 034 |
| Patient Name | Mr. GAGAN SHAW | Contact No | 9007681460 |
| Address | 2 LALIT MOHON BHATTACHARJEE STREET | Age | 17 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 49 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||