Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03165 | Date 09/10/2019 |
| Token No | SM/18-19/6856 09/10/2019 | Serial | 003 |
| Patient Name | Mrs. SALINI MAJUMDAR | Contact No | NOT GIVEN |
| Address | 8 DEY STREET | Age | 36 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||