Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00005 | Date 02/08/2018 |
| Token No | SM/18-19/2367 07/02/2019 | Serial | 008 |
| Patient Name | Mrs. DULARI DEBI | Contact No | 9163899748 |
| Address | 10 DEY STREET | Age | 67 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||