Ticket for Outdoor Patient
| Ward No. | U-PHC No. | Registration No. 00022 | Date 03/08/2018 |
| Token No | SM/18-19/22 03/08/2018 | Serial | 003 |
| Patient Name | Mrs. DIPIKA PAL | Contact No | |
| Address | Age | 34 Female | |
| Token For | Medicine, | Charge | Free |
| B.P | 120/80 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||