Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03217 | Date 18/10/2019 |
| Token No | SM/18-19/6987 18/10/2019 | Serial | 012 |
| Patient Name | Mrs. RANJU DEBI | Contact No | NOT GIVEN |
| Address | 4 DEY GHAT LANE | Age | 25 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||