Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03268 | Date 22/10/2019 |
| Token No | SM/18-19/7113 22/10/2019 | Serial | 028 |
| Patient Name | Miss AYESHA KHATUN | Contact No | 9073383872 |
| Address | 24A K C BHATTCHARYA STREET | Age | 14 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||