Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 01097 | Date 09/10/2018 |
| Token No | SM/18-19/2662 01/03/2019 | Serial | 021 |
| Patient Name | Mrs. ANITA SHAW | Contact No | 9007399280 |
| Address | 67 AKHRABATI LANE | Age | 37 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||