Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03497 | Date 29/11/2019 |
| Token No | SM/19-20/7742 29/11/2019 | Serial | 005 |
| Patient Name | Mrs. SIRIN SULTANA | Contact No | 8005821383 |
| Address | 26 K C BHATTACHARYA STREET | Age | 31 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 67 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||