Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03053 | Date 16/09/2019 |
| Token No | SM/18-19/6814 01/10/2019 | Serial | 004 |
| Patient Name | Mrs. ANSARI BEGUM | Contact No | 8820394467 |
| Address | 26 A K C BHATTACHARYA STREET | Age | 51 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||