Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 03317 | Date 31/10/2019 |
| Token No | SM/18-19/7218 31/10/2019 | Serial | 035 |
| Patient Name | Mrs. GITA DEBI | Contact No | NOT GIVEN |
| Address | WALSH HOSPITAL ROAD | Age | 61 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||