Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02620 | Date 26/07/2019 |
| Token No | SM/18-19/5130 26/07/2019 | Serial | 009 |
| Patient Name | Baby IPSITA KUNDU | Contact No | NOT GIVEN |
| Address | 18 RAM SITA LANE | Age | 7 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||