Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00749 | Date 20/09/2018 |
| Token No | SM/18-19/1002 20/09/2018 | Serial | 002 |
| Patient Name | Mrs. KANTA KANDARA | Contact No | NOT GIVEN |
| Address | RAMSITA LANE | Age | 65 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||