Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00654 | Date 11/09/2018 |
| Token No | SM/18-19/986 18/09/2018 | Serial | 013 |
| Patient Name | Mrs. CHANDA KHATIK | Contact No | NOT GIVEN |
| Address | PAL BAGAN DEY STREET | Age | 59 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 38 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||