Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03615 | Date 14/12/2019 |
| Token No | SM/19-20/8185 02/01/2020 | Serial | 004 |
| Patient Name | Mrs. SIBANI SAHA | Contact No | NOT GIVEN |
| Address | SASHI BHUSAN GHOSH 3RD BYE LANE | Age | 50 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 49 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||