Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00218 | Date 25/08/2018 |
| Token No | SM/18-19/235 25/08/2018 | Serial | 005 |
| Patient Name | Mr. PABITRA APOT | Contact No | |
| Address | DEY STREET | Age | 15 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||