Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 02554 | Date 18/07/2019 |
| Token No | SM/18-19/4976 18/07/2019 | Serial | 002 |
| Patient Name | Mrs. MINTU SHAW | Contact No | NOT GIVEN |
| Address | 23 BARAL BAGAN LANE | Age | 34 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||