Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03056 | Date 16/09/2019 |
| Token No | SM/18-19/6474 16/09/2019 | Serial | 034 |
| Patient Name | Miss ALIVA SANKHA BANIK | Contact No | 8981791250 |
| Address | 32 THAKUR BATI STREET | Age | 7 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||