Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00347 | Date 06/11/2019 |
| Token No | SM/19-20/595 06/11/2019 | Serial | 001 |
| Patient Name | Mrs. RUP KUMARI DAS | Contact No | |
| Address | 30 BAZAR BYE LANE TINBAZAR | Age | 22 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||