Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02153 | Date 31/05/2019 |
| Token No | SM/18-19/3895 31/05/2019 | Serial | 014 |
| Patient Name | Mrs. MANJU DEBI | Contact No | 9062375128 |
| Address | 30 INDIA JUTE MILL | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||