Ticket for Outdoor Patient
| Ward No. 22 | U-PHC No. | Registration No. 01801 | Date 13/03/2019 |
| Token No | SM/18-19/2831 13/03/2019 | Serial | 021 |
| Patient Name | Mrs. BULA SURAI | Contact No | 7595929117 |
| Address | 15 RAILAND CIRCULAR ROAD | Age | 30 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||