Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 00413 | Date 30/08/2018 |
| Token No | SM/18-19/1810 22/11/2018 | Serial | 019 |
| Patient Name | Mrs. NISHA ROY | Contact No | 9874754179 |
| Address | 3 LBS ROAD | Age | 58 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||