Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 03128 | Date 26/09/2019 |
| Token No | SM/18-19/7016 18/10/2019 | Serial | 041 |
| Patient Name | Mrs. ANJALI DUTTA | Contact No | 9432111563 |
| Address | 47 G.T.ROAD MADAM BAGAN | Age | 63 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||