Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01528 | Date 27/12/2018 |
| Token No | SM/18-19/2160 27/12/2018 | Serial | 012 |
| Patient Name | Mrs. GITA NANDI | Contact No | NOT GIVEN |
| Address | 92/A DEY STREET | Age | 55 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||