Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 01016 | Date 28/09/2018 |
| Token No | SM/18-19/1320 28/09/2018 | Serial | 010 |
| Patient Name | Mrs. TULI PRAMANIK | Contact No | 9836680597 |
| Address | 62 DHULI PARA LANE | Age | 22 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||