Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 01601 | Date 22/01/2019 |
| Token No | SM/18-19/4882 19/07/2019 | Serial | 017 |
| Patient Name | Miss PALLABI DAS | Contact No | 9331623210 |
| Address | 68 PATUA PARA LANE | Age | 8 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||