Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03321 | Date 01/11/2019 |
| Token No | SM/18-19/7233 01/11/2019 | Serial | 015 |
| Patient Name | Miss SHREYA SARKAR | Contact No | 7890841994 |
| Address | 2 DAKTAR BAGAN | Age | 16 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||