Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01098 | Date 09/10/2018 |
| Token No | SM/18-19/1444 09/10/2018 | Serial | 012 |
| Patient Name | Miss SANCHITA DEY | Contact No | NOT GIVEN |
| Address | 17 PANCHANAN TALA LANE | Age | 12 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||