Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03456 | Date 21/11/2019 |
| Token No | SM/18-19/7623 21/11/2019 | Serial | 044 |
| Patient Name | Miss SUMANA DEY | Contact No | 8334603869 |
| Address | 1 A B GARDEN LANE | Age | 21 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||