Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01700 | Date 21/02/2019 |
| Token No | SM/18-19/2538 21/02/2019 | Serial | 006 |
| Patient Name | Mrs. SALIMA BIBI | Contact No | NOT GIVEN |
| Address | 50 N L BHATTACHARJEE STREET | Age | 38 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||