Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00235 | Date 25/08/2018 |
| Token No | SM/18-19/2467 14/02/2019 | Serial | 033 |
| Patient Name | Mrs. RUPALI BANERJEE | Contact No | NOT GIVEN |
| Address | 35 R.B SARANI | Age | 40 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||