Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00633 | Date 07/09/2018 |
| Token No | SM/18-19/785 07/09/2018 | Serial | 001 |
| Patient Name | Mrs. MARUPA KHATUN | Contact No | 8420077625 |
| Address | AKC BHATTACHARYA LANE | Age | 24 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||