Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03062 | Date 16/09/2019 |
| Token No | SM/18-19/6499 16/09/2019 | Serial | 059 |
| Patient Name | Miss SUMAIYA KHATUN | Contact No | 9062843642 |
| Address | 49 DR, NANILAL BHATTACHARYA STREET | Age | 9 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||