Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 02633 | Date 29/07/2019 |
| Token No | SM/18-19/5359 02/08/2019 | Serial | 019 |
| Patient Name | Mrs. SUSHAMA DAS | Contact No | 9163035703 |
| Address | 31 AKHRA BATI LANE | Age | 63 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||