Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03600 | Date 12/12/2019 |
| Token No | SM/19-20/8017 12/12/2019 | Serial | 005 |
| Patient Name | Mrs. DIPA CHOWDHURY.. | Contact No | 9007684908 |
| Address | 5 NO BHAGIRATHI LANE | Age | 69 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||