Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00367 | Date 13/08/2018 |
| Token No | SM/18-19/4781 15/07/2019 | Serial | 027 |
| Patient Name | Mrs. MONOJAN BEGUM | Contact No | NOT GIVEN |
| Address | K C BHATTACHARJEE STREET | Age | 30 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||