Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 02942 | Date 30/08/2019 |
| Token No | SM/18-19/6066 30/08/2019 | Serial | 049 |
| Patient Name | Mrs. SEFALI DAS | Contact No | NOT GIVEN |
| Address | PATUA PARA LANE | Age | 60 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||