Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02453 | Date 09/07/2019 |
| Token No | SM/18-19/4705 09/07/2019 | Serial | 021 |
| Patient Name | Miss SANCHITA MITRA | Contact No | NOT GIVEN |
| Address | 14 PANCHANAN TALA LANE | Age | 13 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||