Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02925 | Date 28/08/2019 |
| Token No | SM/18-19/6002 28/08/2019 | Serial | 022 |
| Patient Name | Mrs. SHAMPA ROY | Contact No | 7890882262 |
| Address | TAL PUKUR LOKNATH PALLI | Age | 36 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||