Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01301 | Date 27/11/2018 |
| Token No | SM/18-19/2383 07/02/2019 | Serial | 024 |
| Patient Name | Master K SAI | Contact No | 9331326648 |
| Address | N L BHATTACHARJEE STREET | Age | 5 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||