Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02090 | Date 20/05/2019 |
| Token No | SM/18-19/4148 14/06/2019 | Serial | 006 |
| Patient Name | Miss R LABANYA | Contact No | 8013734489 |
| Address | 44/B/2 N.L. BHATTACHARYA ST | Age | 18 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||