Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 01012 | Date 28/09/2018 |
| Token No | SM/18-19/6160 03/09/2019 | Serial | 007 |
| Patient Name | Mrs. PUJA DEVI | Contact No | NOT GIVEN |
| Address | 22/A K.M. BHATTACHARJEE ST | Age | 27 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||