Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02183 | Date 04/06/2019 |
| Token No | SM/18-19/3965 04/06/2019 | Serial | 020 |
| Patient Name | Baby PUJA KUMARI SHAW | Contact No | 9038101860 |
| Address | RAM SITA LANE NAYABAGAN | Age | 3 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||