Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01794 | Date 13/03/2019 |
| Token No | SM/18-19/4475 27/06/2019 | Serial | 008 |
| Patient Name | Mrs. SHIBANI NATH | Contact No | 9831132602 |
| Address | 15/B KAILASH CHATTERJEE LANE | Age | 25 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||