Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01957 | Date 23/04/2019 |
| Token No | SM/18-19/5526 08/08/2019 | Serial | 013 |
| Patient Name | Miss SUMITA DAS | Contact No | NOT GIVEN |
| Address | 78 DEY STREET | Age | 50 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||