Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01222 | Date 26/10/2018 |
| Token No | SM/18-19/2268 11/01/2019 | Serial | 020 |
| Patient Name | Master SK ALI | Contact No | 8420077625 |
| Address | AKC BHATTACHARYA STREET | Age | 5 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||