Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03428 | Date 19/11/2019 |
| Token No | SM/18-19/7512 19/11/2019 | Serial | 009 |
| Patient Name | Master BHIM ROY | Contact No | 9123750538 |
| Address | DEY STREET | Age | 11 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 22 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||