Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02987 | Date 05/09/2019 |
| Token No | SM/18-19/6223 05/09/2019 | Serial | 005 |
| Patient Name | Miss ANJALI PRASAD | Contact No | 9432444371 |
| Address | 52/A NANILAL BHATTACHARYA STREET | Age | 11 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||