Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 03994 | Date 12/08/2020 |
| Token No | SM/19-20/8823 12/08/2020 | Serial | 005 |
| Patient Name | Mrs. ALOKA DAS | Contact No | 8910850014 |
| Address | 5 AKHRA BATI LANE | Age | 60 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||