Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00657 | Date 11/09/2018 |
| Token No | SM/18-19/1823 27/11/2018 | Serial | 011 |
| Patient Name | Mrs. SRIPATI DEVI | Contact No | NOT GIVEN |
| Address | 9 BECHU DEY LANE | Age | 51 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||