Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02280 | Date 17/06/2019 |
| Token No | SM/18-19/4212 17/06/2019 | Serial | 004 |
| Patient Name | Mrs. SHYAMOLI CHONGDAR | Contact No | NOT GIVEN |
| Address | 86 DEY ST | Age | 68 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||