Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 01715 | Date 26/02/2019 |
| Token No | SM/18-19/2600 26/02/2019 | Serial | 012 |
| Patient Name | Mrs. CHAMPA BISWAS | Contact No | NOT GIVEN |
| Address | 29 K M BHATTACHARJEE STREET | Age | 29 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||