Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04469 | Date 10/06/2021 |
| Token No | SM/21-22/397 10/06/2021 | Serial | 003 |
| Patient Name | Miss BRISTI KOLEY | Contact No | NOT GIVEN |
| Address | PATUA PARA | Age | 13 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||