Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01722 | Date 28/02/2019 |
| Token No | SM/18-19/2621 28/02/2019 | Serial | 005 |
| Patient Name | Mrs. MAYA KAIRI | Contact No | 8481042209 |
| Address | DEY STREET | Age | 31 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||