Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00606 | Date 21/08/2018 |
| Token No | SM/18-19/1013 20/09/2018 | Serial | 013 |
| Patient Name | Mrs. JAYANTI CHAKRABORTY | Contact No | 9163459946 |
| Address | DHANNOHANA, NALIKUL | Age | 53 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||