Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01353 | Date 11/12/2018 |
| Token No | SM/18-19/1919 11/12/2018 | Serial | 007 |
| Patient Name | Mrs. MANJILA BEGUM | Contact No | 8334072423 |
| Address | K.C BHATTACHARYA ST | Age | 28 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||