Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03491 | Date 28/11/2019 |
| Token No | SM/19-20/7725 28/11/2019 | Serial | 027 |
| Patient Name | Mrs. SANDITA RAKSHIT | Contact No | 9674510989 |
| Address | PATUA PARA LANE | Age | 54 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||