Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 01630 | Date 07/02/2019 |
| Token No | SM/18-19/2526 19/02/2019 | Serial | 027 |
| Patient Name | Mrs. NILAM DEBI | Contact No | NOT GIVEN |
| Address | 62 RAILAND ROAD | Age | 40 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||