Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00281 | Date 11/08/2018 |
| Token No | SM/18-19/1704 31/10/2018 | Serial | 021 |
| Patient Name | Miss NANDITA DAS | Contact No | |
| Address | Age | 32 Female | |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||