Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00306 | Date 28/08/2018 |
| Token No | SM/18-19/4768 15/07/2019 | Serial | 014 |
| Patient Name | Mrs. BASANTI SHA | Contact No | NOT GIVEN |
| Address | 79 B DEY STREET | Age | 52 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||