Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01831 | Date 28/03/2019 |
| Token No | SM/18-19/3039 04/04/2019 | Serial | 014 |
| Patient Name | Mrs. SIKHA RANI DEY | Contact No | 8820673597 |
| Address | 86/C/A DEY STREET | Age | 59 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||