Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01129 | Date 11/10/2018 |
| Token No | SM/18-19/1510 11/10/2018 | Serial | 001 |
| Patient Name | Mrs. MAYA KOIRI | Contact No | 8481042209 |
| Address | DEY BARI, DEY STREET | Age | 37 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||