Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02587 | Date 23/07/2019 |
| Token No | SM/18-19/5063 23/07/2019 | Serial | 030 |
| Patient Name | Miss AFSANA KHATUN | Contact No | |
| Address | K.C.BHATTACHARYA ST | Age | 13 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||