Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02378 | Date 28/06/2019 |
| Token No | SM/18-19/4525 28/06/2019 | Serial | 015 |
| Patient Name | Mrs. TETRI DEBI | Contact No | NOT GIVEN |
| Address | 13 DEY GHAT LANE | Age | 50 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||