Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 02758 | Date 07/08/2019 |
| Token No | SM/18-19/5500 07/08/2019 | Serial | 016 |
| Patient Name | Mrs. HEMA MAITY | Contact No | 9051971781 |
| Address | 27 AKHRA BATI LANE | Age | 41 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||