Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 02762 | Date 07/08/2019 |
| Token No | SM/18-19/5506 07/08/2019 | Serial | 022 |
| Patient Name | Mrs. GAYETRI GHOSH | Contact No | NOT GIVEN |
| Address | 160 A JITEN LAHIRI ROAD | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||