Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02154 | Date 31/05/2019 |
| Token No | SM/18-19/3900 31/05/2019 | Serial | 019 |
| Patient Name | Master SHIB PRATAP SHAW | Contact No | NOT GIVEN |
| Address | NAYABAGAN INDIA JUTEMILL | Age | 10 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||