Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01703 | Date 21/02/2019 |
| Token No | SM/18-19/2545 21/02/2019 | Serial | 013 |
| Patient Name | Mrs. OMRAWATI DEVI | Contact No | NOT GIVEN |
| Address | NAYA BAGAN RAM SITA LANE | Age | 40 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||