Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 02200 | Date 06/06/2019 |
| Token No | SM/18-19/3999 06/06/2019 | Serial | 024 |
| Patient Name | Miss SWASTIKA CHAKRABORTY | Contact No | 9007694703 |
| Address | 7 PATUA PARA LANE | Age | 16 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||