Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01594 | Date 22/01/2019 |
| Token No | SM/18-19/2644 01/03/2019 | Serial | 003 |
| Patient Name | Mrs. SIKHA DAS | Contact No | 9903656344 |
| Address | 17/1 KALITALA LANE | Age | 40 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||