Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01161 | Date 04/09/2018 |
| Token No | SM/18-19/1563 04/09/2018 | Serial | 019 |
| Patient Name | Mrs. MOUSUMI DAS | Contact No | |
| Address | Age | 48 Y Female | |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||