Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01276 | Date 02/11/2018 |
| Token No | SM/18-19/1757 02/11/2018 | Serial | 009 |
| Patient Name | Miss MONOHARA KHATUN | Contact No | 9123810412 |
| Address | 24A N L BHATTACHARJEE STREET | Age | 17 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||