Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 02500 | Date 18/07/2019 |
| Token No | SM/18-19/4850 18/07/2019 | Serial | 028 |
| Patient Name | Mrs. MAMONI SHIL | Contact No | NOT GIVEN |
| Address | 119 BHAGIRATHI LANE | Age | 26 Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||