Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01145 | Date 12/10/2018 |
| Token No | SM/18-19/3697 17/05/2019 | Serial | 001 |
| Patient Name | Mrs. PARBATI DEY | Contact No | NOT GIVEN |
| Address | 12/A KASHI DOCTOR LANE | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||