Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03054 | Date 16/09/2019 |
| Token No | SM/18-19/6468 16/09/2019 | Serial | 028 |
| Patient Name | Mr. AMRIK GIRI | Contact No | 9433640733 |
| Address | 4 DEY GHAT LANE | Age | 11 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||