Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02629 | Date 26/07/2019 |
| Token No | SM/18-19/5176 26/07/2019 | Serial | 055 |
| Patient Name | Mrs. SHAMPA DEY | Contact No | 9339981211 |
| Address | 4 CHOWDHURY PARA | Age | 37 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||