Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01814 | Date 19/03/2019 |
| Token No | SM/18-19/3092 05/04/2019 | Serial | 006 |
| Patient Name | Mr. SK SAMIM | Contact No | 6290367837 |
| Address | 13 A.K.C BHATTACHARYA ST | Age | 18 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||