Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00111 | Date 07/08/2018 |
| Token No | SM/18-19/115 07/08/2018 | Serial | 011 |
| Patient Name | Mrs. SARADA KOIRI | Contact No | |
| Address | 79, DEY STREET | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | 120/80 mmHg | Weight | KG |
| Pulse Rate | 80 / min | Height | cm |
| Diagnosis | |||