Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01304 | Date 27/11/2018 |
| Token No | SM/18-19/2333 01/02/2019 | Serial | 005 |
| Patient Name | Mrs. MANTI DEBI | Contact No | NOT GIVEN |
| Address | NEAR B S N L OFFICE | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||