Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00678 | Date 13/09/2018 |
| Token No | SM/18-19/6839 01/10/2019 | Serial | 029 |
| Patient Name | Mrs. CHHABI CHONGDER | Contact No | 8697504530 |
| Address | 86 DEY STREET | Age | 58 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||