Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00158 | Date 16/09/2019 |
| Token No | SM/19-20/172 16/09/2019 | Serial | 036 |
| Patient Name | Mrs. DIPALI MAITY | Contact No | 8478923339 |
| Address | CHOTOBELU BELIMILKI 712203 | Age | 52 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||