Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 02105 | Date 23/05/2019 |
| Token No | SM/18-19/3803 27/05/2019 | Serial | 006 |
| Patient Name | Mrs. SWARNAMOYEE SEN | Contact No | 9062533035 |
| Address | 15 SADGOPE PARA LANE | Age | 46 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||