Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01358 | Date 11/12/2018 |
| Token No | SM/18-19/3470 30/04/2019 | Serial | 011 |
| Patient Name | Mrs. BASANTI DEVI | Contact No | NOT GIVEN |
| Address | 79 DEY ST | Age | 51 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||