Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 02732 | Date 06/08/2019 |
| Token No | SM/18-19/5441 06/08/2019 | Serial | 020 |
| Patient Name | Miss PRIYA MODI | Contact No | 9477931706 |
| Address | 21/1 SASHI BHUSAN GHOSH LANE | Age | 14 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||