Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01573 | Date 15/01/2019 |
| Token No | SM/18-19/2275 15/01/2019 | Serial | 006 |
| Patient Name | Miss KALPANA PRADHAN | Contact No | 9123642042 |
| Address | 14D DEY ST | Age | 17 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||