Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01099 | Date 09/10/2018 |
| Token No | SM/18-19/1445 09/10/2018 | Serial | 013 |
| Patient Name | Mrs. TUKUNI PRADHAN | Contact No | NOT GIVEN |
| Address | 45 N.L BHATTACHRYA STREET | Age | 23 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||