Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00210 | Date 17/08/2018 |
| Token No | SM/18-19/1446 09/10/2018 | Serial | 014 |
| Patient Name | Mrs. DUKKHI JENNA | Contact No | 9007258708 |
| Address | 45 COCKRAIN ROAD | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||