Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03358 | Date 11/11/2019 |
| Token No | SM/18-19/7630 21/11/2019 | Serial | 051 |
| Patient Name | Mrs. MOUSUMI MOULICK | Contact No | 7595989037 |
| Address | 43 PRAVAS NAGAR | Age | 32 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||