Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00514 | Date 20/08/2018 |
| Token No | SM/18-19/2893 19/03/2019 | Serial | 027 |
| Patient Name | Mrs. KAMALA SAMON | Contact No | 9339820034 |
| Address | 21,CHOWDHURI PARA LANE | Age | 46 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||