Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01691 | Date 19/02/2019 |
| Token No | SM/18-19/2511 19/02/2019 | Serial | 012 |
| Patient Name | Master MANJIT ROY | Contact No | NOT GIVEN |
| Address | 9 BEVHU DEY LANE | Age | 10 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||