Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03153 | Date 01/10/2019 |
| Token No | SM/18-19/6824 01/10/2019 | Serial | 014 |
| Patient Name | Master ADAR SHAW | Contact No | 9681818854 |
| Address | 52/A PANCHNAN TALA LANE | Age | 4 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||