Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00112 | Date 07/08/2018 |
| Token No | SM/18-19/1743 01/11/2018 | Serial | 020 |
| Patient Name | Mrs. MIRA DAS | Contact No | 8336852935 |
| Address | GHOSH PARA 1 ST LANE | Age | 61 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||