Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 01581 | Date 17/01/2019 |
| Token No | SM/18-19/2311 22/01/2019 | Serial | 007 |
| Patient Name | Mr. HABIB HUSSAAIN | Contact No | 9748153381 |
| Address | 16 K M SHA STREET | Age | 27 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||