Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 01603 | Date 22/01/2019 |
| Token No | SM/18-19/2323 22/01/2019 | Serial | 019 |
| Patient Name | Mrs. SIULI SANA | Contact No | 7699331410 |
| Address | 50/B PATUA PARA LANE | Age | 24 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||