Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03237 | Date 19/10/2019 |
| Token No | SM/18-19/7033 19/10/2019 | Serial | 006 |
| Patient Name | Mrs. MANGALA KARMAKAR | Contact No | NOT GIVEN |
| Address | SHEORAFULI SHIBTALA BYE LANE | Age | 31 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||