Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01880 | Date 04/04/2019 |
| Token No | SM/18-19/6795 30/09/2019 | Serial | 020 |
| Patient Name | Miss SONALI BAG | Contact No | 8902650222 |
| Address | 4 A.B GARDEN LANE | Age | 10 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||