Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 03936 | Date 18/03/2020 |
| Token No | SM/19-20/8725 18/03/2020 | Serial | 007 |
| Patient Name | Mrs. BULA DAS | Contact No | NOT GIVEN |
| Address | 42 G T ROAD, KALITALA, MADAM BAGAN | Age | 53 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 47 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||