Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03145 | Date 30/09/2019 |
| Token No | SM/18-19/6800 30/09/2019 | Serial | 025 |
| Patient Name | Master INJAL KOIRI | Contact No | 8481042209 |
| Address | DEY GHAT LANE | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||