Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01011 | Date 28/09/2018 |
| Token No | SM/18-19/5055 23/07/2019 | Serial | 022 |
| Patient Name | Baby SANJANA KUMARI | Contact No | NOT GIVEN |
| Address | GOPAL GANGULY LANE | Age | 4 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||