Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03411 | Date 18/11/2019 |
| Token No | SM/18-19/7470 18/11/2019 | Serial | 012 |
| Patient Name | Miss RABANA KHATUN | Contact No | NOT GIVEN |
| Address | A K C BHATTACHARYA STREET | Age | 5 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||