Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00628 | Date 06/09/2018 |
| Token No | SM/18-19/5238 30/07/2019 | Serial | 003 |
| Patient Name | Mrs. RUMA KUNDU | Contact No | 9748461778 |
| Address | 33 PANDIT K.N BHATTACHARYA STREET | Age | 30 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||