Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02779 | Date 09/08/2019 |
| Token No | SM/18-19/5567 09/08/2019 | Serial | 016 |
| Patient Name | Mrs. SIULI SHIL | Contact No | 9088372428 |
| Address | TALPUKUR PROMOD PALLY | Age | 32 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||