Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01552 | Date 08/01/2019 |
| Token No | SM/18-19/2226 08/01/2019 | Serial | 007 |
| Patient Name | Miss MAHARUMA NAHARIN | Contact No | 9830391513 |
| Address | 37 DEY ST | Age | 11 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||