Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00140 | Date 08/08/2018 |
| Token No | SM/18-19/3167 09/04/2019 | Serial | 022 |
| Patient Name | Mrs. GULABI DEBI.. | Contact No | not given |
| Address | DEY GHAT LANE | Age | 55 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||