Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 00363 | Date 13/08/2018 |
| Token No | SM/18-19/3626 13/05/2019 | Serial | 020 |
| Patient Name | Mrs. LAXMI GHOSH | Contact No | 890271882 |
| Address | 25A/9 FIRINGI DANGA ROAD | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||