Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 02024 | Date 03/05/2019 |
| Token No | SM/18-19/3666 16/05/2019 | Serial | 006 |
| Patient Name | Mrs. REKHA DAS | Contact No | NOT GIVEN |
| Address | 57/A THAKURBATI ST | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||