Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01446 | Date 20/12/2018 |
| Token No | SM/18-19/2319 22/01/2019 | Serial | 015 |
| Patient Name | Mrs. CHANDRA BATI MALLICK | Contact No | NOT GIVEN |
| Address | DEY STREET | Age | 70 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||