Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01694 | Date 19/02/2019 |
| Token No | SM/18-19/2521 19/02/2019 | Serial | 022 |
| Patient Name | Mrs. PUTUL MALLICK | Contact No | NOT GIVEN |
| Address | DEY STREET, JALKAL OFFICE | Age | 35 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||