Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03127 | Date 26/09/2019 |
| Token No | SM/18-19/6715 26/09/2019 | Serial | 026 |
| Patient Name | Mrs. SIKHA DAS | Contact No | 9804791068 |
| Address | 9 NO PATUA PARA | Age | 46 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||