Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00474 | Date 14/08/2018 |
| Token No | SM/18-19/2786 12/03/2019 | Serial | 002 |
| Patient Name | Mrs. SABITRI RAJBHAR | Contact No | 7605808134 |
| Address | 10 DEY STREET | Age | 46 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||