Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03424 | Date 19/11/2019 |
| Token No | SM/18-19/7505 19/11/2019 | Serial | 002 |
| Patient Name | Miss KHUSBU PHATIK | Contact No | 9088144150 |
| Address | DEY STREET | Age | 20 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 59 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||