Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00138 | Date 08/08/2018 |
| Token No | SM/18-19/745 01/09/2018 | Serial | 001 |
| Patient Name | Mrs. CHANDRAMA PRADHAN | Contact No | 8777631750 |
| Address | 9, N.L BHATTACHARYA STREET | Age | 55 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||