Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02962 | Date 01/09/2019 |
| Token No | SM/18-19/6125 01/09/2019 | Serial | 017 |
| Patient Name | Miss ARPITA SHAW | Contact No | 9874440016 |
| Address | RAM SITA LINE 6 NO NAYA BAGAN | Age | 6 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||