Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01259 | Date 01/11/2018 |
| Token No | SM/18-19/1727 01/11/2018 | Serial | 004 |
| Patient Name | Mrs. URMILA DEBI | Contact No | 9330385093 |
| Address | 4 DEY GHAT LANE | Age | 41 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||