Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 00139 | Date 16/09/2019 |
| Token No | SM/19-20/3584 01/04/2020 | Serial | 025 |
| Patient Name | Mr. SAMAR DAS | Contact No | 9836814946 |
| Address | 57J/B G T ROAD PAMPANAGAR MAIDYABATI M 712204 | Age | 68 YRS Male |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||