Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01746 | Date 05/03/2019 |
| Token No | SM/18-19/2684 05/03/2019 | Serial | 016 |
| Patient Name | Miss AJIMA KHATUN | Contact No | 8017727336 |
| Address | 50 N L BHATTACHARJEE STREET | Age | 11 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||