Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01536 | Date 28/12/2018 |
| Token No | SM/18-19/3245 16/04/2019 | Serial | 014 |
| Patient Name | Mrs. IVA KUNDU | Contact No | 26620834 |
| Address | 92/B DEY STREET | Age | 62 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||