Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 00389 | Date 13/08/2018 |
| Token No | SM/18-19/2722 07/03/2019 | Serial | 009 |
| Patient Name | Mrs. SUSMITA GHOSH | Contact No | 8276923567 |
| Address | 34/B BAISNAB PARA 2ND LANE | Age | 24 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||