Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03365 | Date 14/11/2019 |
| Token No | SM/18-19/7372 14/11/2019 | Serial | 020 |
| Patient Name | Miss LAXMI DAS | Contact No | 8420308867 |
| Address | 573 G T ROAD MANIKTALA | Age | 18 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||