Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01297 | Date 22/11/2018 |
| Token No | SM/18-19/1805 22/11/2018 | Serial | 014 |
| Patient Name | Mrs. FULMANI SOREL | Contact No | NOT GIVEN |
| Address | TARAKESWAR | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||