Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02252 | Date 13/06/2019 |
| Token No | SM/18-19/4136 13/06/2019 | Serial | 026 |
| Patient Name | Mr. SUMIT JANA | Contact No | 9038801477 |
| Address | 9/438 INDIA JUTE MILL | Age | 15 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||