Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01444 | Date 20/12/2018 |
| Token No | SM/18-19/2056 20/12/2018 | Serial | 004 |
| Patient Name | Miss G SEYA | Contact No | 9903531379 |
| Address | N L BHATTACHARJEE STREET | Age | 12 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||