Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00335 | Date 29/08/2018 |
| Token No | SM/18-19/2726 08/03/2019 | Serial | 004 |
| Patient Name | Mrs. BULA DEY | Contact No | 8961443140 |
| Address | 90C/5 DEY STREET | Age | 54 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||