Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01747 | Date 05/03/2019 |
| Token No | SM/18-19/2685 05/03/2019 | Serial | 017 |
| Patient Name | Mrs. SELIMA BEGUM | Contact No | |
| Address | 50 NANILAL BHATTACHARYA ST | Age | 38 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||