Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01497 | Date 21/12/2018 |
| Token No | SM/18-19/3099 05/04/2019 | Serial | 013 |
| Patient Name | Mrs. SARASWATI DAS | Contact No | 8584937067 |
| Address | 5 NO BECHUDEY LANE | Age | 57 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||