Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01832 | Date 28/03/2019 |
| Token No | SM/18-19/2937 28/03/2019 | Serial | 017 |
| Patient Name | Master BINOY KR SHA | Contact No | NOT GIVEN |
| Address | 10NO LINE | Age | 13 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||