Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01498 | Date 21/12/2018 |
| Token No | SM/18-19/2153 27/12/2018 | Serial | 005 |
| Patient Name | Mrs. ALPANA DAS | Contact No | 8013281928 |
| Address | 5 BECHU DEY LANE | Age | 56 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||