Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 02759 | Date 07/08/2019 |
| Token No | SM/18-19/5501 07/08/2019 | Serial | 017 |
| Patient Name | Mrs. MOUSUMI MAHATO | Contact No | 9830088078 |
| Address | 35 NABAKRISHNO GUI LANE | Age | 38 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||