Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00031 | Date 03/08/2018 |
| Token No | SM/18-19/1656 30/10/2018 | Serial | 008 |
| Patient Name | Mrs. G KAMALA | Contact No | NOT GIVEN |
| Address | N L BHATTACHARJEE STREET | Age | 71 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||