Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01133 | Date 11/10/2018 |
| Token No | SM/18-19/1519 11/10/2018 | Serial | 010 |
| Patient Name | Mrs. KABITA PAL | Contact No | 9748546483 |
| Address | 86 DEY STREET | Age | 48 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||