Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01924 | Date 16/04/2019 |
| Token No | SM/18-19/4970 19/07/2019 | Serial | 011 |
| Patient Name | Mrs. SUMITRA DEBI | Contact No | NOT GIVEN |
| Address | 103 R B SARANI | Age | 60 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||