Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00442 | Date 14/08/2018 |
| Token No | SM/18-19/2156 27/12/2018 | Serial | 008 |
| Patient Name | Mrs. SOMA DAS | Contact No | 7998666812 |
| Address | 3/C CHATRA GHOSH PARA | Age | 35 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||