Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03377 | Date 14/11/2019 |
| Token No | SM/18-19/7396 14/11/2019 | Serial | 044 |
| Patient Name | Miss DIPA DEY | Contact No | 9883745122 |
| Address | 6/A 16/C BHAGIRATHI LANE | Age | 26 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||