Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01993 | Date 29/04/2019 |
| Token No | SM/18-19/3429 29/04/2019 | Serial | 003 |
| Patient Name | Miss EKTA KHATUN | Contact No | 8017727336 |
| Address | 50 DR. NANILAL BHATTACHARJEE STREET | Age | 9 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||