Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02230 | Date 11/06/2019 |
| Token No | SM/18-19/4083 11/06/2019 | Serial | 014 |
| Patient Name | Miss KRISHNA ROY | Contact No | |
| Address | 4 DEY GHAT LANE | Age | 16 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||