Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00985 | Date 27/09/2018 |
| Token No | SM/18-19/6556 19/09/2019 | Serial | 016 |
| Patient Name | Miss MONALISA PAL | Contact No | 9007752705 |
| Address | 11/318 JUTE MILL LINE | Age | 8 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||