Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01983 | Date 26/04/2019 |
| Token No | SM/18-19/3407 26/04/2019 | Serial | 003 |
| Patient Name | Miss PUNAM ROY | Contact No | NOT GIVEN |
| Address | DEY ST | Age | 22 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||