Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01568 | Date 11/01/2019 |
| Token No | SM/18-19/2261 11/01/2019 | Serial | 013 |
| Patient Name | Mrs. NAMITA GANGULY | Contact No | NOT GIVEN |
| Address | 28 PANCHANAN TALA LANE | Age | 47 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||