Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 02012 | Date 02/05/2019 |
| Token No | SM/18-19/3902 31/05/2019 | Serial | 021 |
| Patient Name | Mrs. MOUSUMI GHOSH | Contact No | 8334961215 |
| Address | 39 SHASHIBHUSAN GHOSH LANE | Age | 40 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||