Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01569 | Date 11/01/2019 |
| Token No | SM/18-19/2264 11/01/2019 | Serial | 016 |
| Patient Name | Mrs. SHYAMALI CHONGDAR | Contact No | 8697504530 |
| Address | 86 DEY ST | Age | 69 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||