Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00681 | Date 13/09/2018 |
| Token No | SM/18-19/917 13/09/2018 | Serial | 006 |
| Patient Name | Mrs. DIPALI DAS | Contact No | NOT GIVEN |
| Address | 16A KAILASH CHATTERJEE LANE | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||