Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01681 | Date 15/02/2019 |
| Token No | SM/18-19/2485 15/02/2019 | Serial | 014 |
| Patient Name | Mrs. BINODINI BARIK | Contact No | 9007258708 |
| Address | 45 N L BHATTACHARYA STREET | Age | 35 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||