Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01298 | Date 22/11/2018 |
| Token No | SM/18-19/3278 18/04/2019 | Serial | 022 |
| Patient Name | Mrs. CHANDANA DEY | Contact No | 6289382673 |
| Address | 4 DEY ST | Age | 38 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||