Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03060 | Date 16/09/2019 |
| Token No | SM/18-19/6492 16/09/2019 | Serial | 052 |
| Patient Name | Mrs. JAIDA BIBI | Contact No | NOT GIVEN |
| Address | 41 K M BHATTACHARYA STREET | Age | 51 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||