Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00626 | Date 06/09/2018 |
| Token No | SM/18-19/1835 29/11/2018 | Serial | 003 |
| Patient Name | Mrs. RUPALI PAL | Contact No | 9748461778 |
| Address | 33, PANDIT KALI NATH BHATTACHARYA STREET | Age | 51 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||