Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00030 | Date 03/08/2018 |
| Token No | SM/19-20/8089 16/12/2019 | Serial | 020 |
| Patient Name | Mrs. RADHA BARIK | Contact No | 8282932054 |
| Address | 45 N.L BHATTACHARYA ST | Age | 57 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||