Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02301 | Date 18/06/2019 |
| Token No | SM/18-19/4261 18/06/2019 | Serial | 015 |
| Patient Name | Miss ANJALI PRASAD | Contact No | NOT GIVEN |
| Address | 52 N.L.BHATTACHARYA ST | Age | 10 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||