Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 02637 | Date 29/07/2019 |
| Token No | SM/18-19/5448 06/08/2019 | Serial | 027 |
| Patient Name | Mrs. RASHMONI SHIL | Contact No | NOT GIVEN |
| Address | 119 BHAGIRATHI LANE | Age | 60 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||