Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01674 | Date 15/02/2019 |
| Token No | SM/18-19/2731 08/03/2019 | Serial | 009 |
| Patient Name | Mrs. CHABI DAS | Contact No | 8420222891 |
| Address | 27 DEY STREET | Age | 67 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||