Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00283 | Date 09/08/2018 |
| Token No | SM/18-19/313 09/08/2018 | Serial | 001 |
| Patient Name | Master DEBESH APOT | Contact No | |
| Address | COCKRAIN ROAD | Age | 5 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 18 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||