Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01551 | Date 04/01/2019 |
| Token No | SM/18-19/2217 04/01/2019 | Serial | 012 |
| Patient Name | Master NAMAN RAM | Contact No | 9477228074 |
| Address | 7 NO DEY GHAT LANE | Age | 12 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||