Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 00984 | Date 27/09/2018 |
| Token No | SM/18-19/2060 20/12/2018 | Serial | 008 |
| Patient Name | Mrs. NIRMALA ROY | Contact No | NOT GIVEN |
| Address | 60 PATUA PARA LANE | Age | 55 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||