Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01010 | Date 28/09/2018 |
| Token No | SM/18-19/1311 28/09/2018 | Serial | 001 |
| Patient Name | Mrs. TAMALI CHATTERJEE | Contact No | 9875680939 |
| Address | 52/A PANCHANAN TALA LANE | Age | 53 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||