Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00682 | Date 13/09/2018 |
| Token No | SM/18-19/3248 16/04/2019 | Serial | 017 |
| Patient Name | Mrs. GAYETRI DEBI | Contact No | 6291618593 |
| Address | 1 NO DEY GHAT LANE | Age | 46 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||