Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01997 | Date 29/04/2019 |
| Token No | SM/18-19/3436 29/04/2019 | Serial | 010 |
| Patient Name | Mrs. CHAMELI ROY | Contact No | 8697318143 |
| Address | 18 PANCHANAN TALA LANE | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||