Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00756 | Date 20/09/2018 |
| Token No | SM/18-19/1580 07/09/2018 | Serial | 001 |
| Patient Name | Miss RIMPA JANA | Contact No | 7602769691 |
| Address | TARAKESWAR | Age | 23 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||