Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00631 | Date 06/09/2018 |
| Token No | SM/18-19/776 06/09/2018 | Serial | 014 |
| Patient Name | Miss SUMONA DEY | Contact No | |
| Address | 1, A.B GARDEN LANE | Age | 20 Female |
| Token For | Medicine, | Charge | Free |
| B.P | 100/70 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||