Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01772 | Date 10/03/2019 |
| Token No | SM/18-19/2759 10/03/2019 | Serial | 001 |
| Patient Name | Mrs. BHARATI GHOSH | Contact No | NOT GIVEN |
| Address | 44 JITEN LAHIRI ROAD | Age | 67 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||