Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00757 | Date 20/09/2018 |
| Token No | SM/18-19/1019 20/09/2018 | Serial | 019 |
| Patient Name | Mr. SOUMAJIT DEY | Contact No | |
| Address | DEY STREET | Age | 16 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||