Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03433 | Date 19/11/2019 |
| Token No | SM/18-19/7525 19/11/2019 | Serial | 022 |
| Patient Name | Master DIPAYAN KOIRI | Contact No | 8961451363 |
| Address | 8 A K C BHATTACHARJEE STREET | Age | 10 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||