Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02508 | Date 19/07/2019 |
| Token No | SM/18-19/4870 19/07/2019 | Serial | 005 |
| Patient Name | Master SUBRATA JOT | Contact No | 7439521158 |
| Address | 10 DOSTI LANE | Age | 8 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||