Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03149 | Date 30/09/2019 |
| Token No | SM/18-19/6810 30/09/2019 | Serial | 035 |
| Patient Name | Mrs. KAJAL DAS DEY | Contact No | 8013295705 |
| Address | 14 K.C.LANE | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||