Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01937 | Date 18/04/2019 |
| Token No | SM/18-19/3282 18/04/2019 | Serial | 026 |
| Patient Name | Miss KABITA SHA | Contact No | |
| Address | RAM SITA LANE | Age | 22 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||