Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03076 | Date 19/09/2019 |
| Token No | SM/18-19/6562 19/09/2019 | Serial | 022 |
| Patient Name | Mrs. BOBY ROY | Contact No | NOT GIVEN |
| Address | TARAPUKUR | Age | 40 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||