Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 01813 | Date 19/03/2019 |
| Token No | SM/18-19/6505 17/09/2019 | Serial | 005 |
| Patient Name | Mrs. ANJALI DAS | Contact No | NOT GIVEN |
| Address | 25 DEY BAGAN LANE | Age | 60 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||