Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00099 | Date 06/08/2018 |
| Token No | SM/18-19/3643 14/05/2019 | Serial | 015 |
| Patient Name | Mrs. AMARABATI DEBI | Contact No | 7890265309 |
| Address | 79 DEY STREET | Age | 58 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||