Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00987 | Date 27/09/2018 |
| Token No | SM/18-19/1284 27/09/2018 | Serial | 024 |
| Patient Name | Mrs. JAYANTI BISWAL | Contact No | 8420489009 |
| Address | 45 N. L BHATTACHARYA STREET | Age | 29 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||