Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00715 | Date 14/09/2018 |
| Token No | SM/18-19/957 14/09/2018 | Serial | 009 |
| Patient Name | Mrs. ROMILA PRADHAN | Contact No | NOT GIVEN |
| Address | 9 INDIAN JUTE MILL LINE | Age | 41 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||