Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03985 | Date 14/07/2020 |
| Token No | SM/19-20/8811 14/07/2020 | Serial | 009 |
| Patient Name | Mrs. SUJATA DAS | Contact No | 8820160669 |
| Address | 6 RUDRA RAM PANDIT LANE | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||