Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02379 | Date 28/06/2019 |
| Token No | SM/18-19/4526 28/06/2019 | Serial | 016 |
| Patient Name | Mrs. KOSHILA DEVI | Contact No | 9748923834 |
| Address | 21A K.C.BHATTACHARYA ST | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||