Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 00125 | Date 13/09/2019 |
| Token No | SM/19-20/991 06/12/2019 | Serial | 012 |
| Patient Name | Mr. BRAJOGOPAL SARKAR | Contact No | 9748654746 |
| Address | CHAKLAPARA,PRABASHNAGAR | Age | 90 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||