Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00758 | Date 20/09/2018 |
| Token No | SM/18-19/1020 20/09/2018 | Serial | 020 |
| Patient Name | Mrs. LAKSHMI GHOSH | Contact No | NOT GIVEN |
| Address | 25A/9 FIRINGI DANGA ROAD | Age | 58 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||