Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00199 | Date 17/08/2018 |
| Token No | SM/18-19/2397 08/02/2019 | Serial | 012 |
| Patient Name | Master G. SLOKE | Contact No | 9903531379 |
| Address | COCKRAIN ROAD | Age | 9 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||