Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02003 | Date 30/04/2019 |
| Token No | SM/18-19/3475 30/04/2019 | Serial | 016 |
| Patient Name | Miss TRASTI KUMARI | Contact No | 9874440016 |
| Address | 6 NAYA BAGAN | Age | 7 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||