Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 00769 | Date 21/01/2020 |
| Token No | SM/19-20/1694 21/01/2020 | Serial | 006 |
| Patient Name | Mr. LAKSHMIKANTA DAS | Contact No | 9874011053 |
| Address | 65/14/2 GURU GARDEN ROAD PRABASHNAGAR 712249 | Age | 79 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||