Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02820 | Date 16/08/2019 |
| Token No | SM/18-19/6493 16/09/2019 | Serial | 053 |
| Patient Name | Miss SALMA KHATUN | Contact No | NOT GIVEN |
| Address | K.M.BHATTACHARYA ST | Age | 24 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||