Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01887 | Date 05/04/2019 |
| Token No | SM/18-19/3602 10/05/2019 | Serial | 028 |
| Patient Name | Mrs. SILA DEVI | Contact No | NOT GIVEN |
| Address | 6 DEY GHAT LANE | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||