Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00004 | Date 02/08/2018 |
| Token No | SM/18-19/4 02/08/2018 | Serial | 003 |
| Patient Name | Mrs. RAMALA DEBI | Contact No | |
| Address | DEY ST | Age | 42 Female |
| Token For | Medicine, | Charge | Free |
| B.P | 170/90 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||