Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02631 | Date 26/07/2019 |
| Token No | SM/18-19/5185 26/07/2019 | Serial | 064 |
| Patient Name | Mrs. DOLI MUKHERJEE | Contact No | NOT GIVEN |
| Address | SEORAPHULI SHIB TALA | Age | 38 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||