Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00402 | Date 30/08/2018 |
| Token No | SM/18-19/1438 09/10/2018 | Serial | 006 |
| Patient Name | Mrs. MEHEMUNARA BEGUM | Contact No | 8820074455 |
| Address | 13K.C BHATTACHARYA STREET | Age | 54 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||