Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03122 | Date 26/09/2019 |
| Token No | SM/18-19/6704 26/09/2019 | Serial | 015 |
| Patient Name | Mr. GANGA SHA | Contact No | NOT GIVEN |
| Address | NAYA BAGAN | Age | 60 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||