Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01643 | Date 12/02/2019 |
| Token No | SM/18-19/2642 01/03/2019 | Serial | 001 |
| Patient Name | Miss KUMKUM KUMARI SHA | Contact No | 7003693465 |
| Address | 3 DEY STREET | Age | 13 Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||