Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03371 | Date 14/11/2019 |
| Token No | SM/18-19/7389 14/11/2019 | Serial | 037 |
| Patient Name | Mrs. FUL KUMARI DEVI | Contact No | NOT GIVEN |
| Address | K.M.BHATTACHARYA ST | Age | 37 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||