Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03352 | Date 11/11/2019 |
| Token No | SM/18-19/7341 11/11/2019 | Serial | 025 |
| Patient Name | Miss MOHONA DEY | Contact No | 9804028249 |
| Address | 1/A BECHU DEY LANE | Age | 23 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||