Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01359 | Date 11/12/2018 |
| Token No | SM/18-19/1929 11/12/2018 | Serial | 017 |
| Patient Name | Master ABHISEKH DAS | Contact No | NOT GIVEN |
| Address | 14 b dey street | Age | 15 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||