Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02630 | Date 26/07/2019 |
| Token No | SM/18-19/5182 26/07/2019 | Serial | 061 |
| Patient Name | Mrs. SHRADDHA GOSWAMI | Contact No | NOT GIVEN |
| Address | 1NO INDIA JUTE MILL | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||