Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 02801 | Date 13/08/2019 |
| Token No | SM/19-20/7814 02/12/2019 | Serial | 019 |
| Patient Name | Mrs. POILA BAG | Contact No | NOT GIVEN |
| Address | BELTING BAZAR | Age | 60 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||