Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 02062 | Date 16/05/2019 |
| Token No | SM/18-19/6931 15/10/2019 | Serial | 023 |
| Patient Name | Mrs. NITU DAS | Contact No | 9830706830 |
| Address | 120 POTUA PARA LANE | Age | 39 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||