Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03318 | Date 01/11/2019 |
| Token No | SM/18-19/7223 01/11/2019 | Serial | 005 |
| Patient Name | Master DIPAK BISWAL | Contact No | 9123997928 |
| Address | 45 DR. N L BHATTACHARYA STREET | Age | 14 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||