Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02000 | Date 30/04/2019 |
| Token No | SM/18-19/3467 30/04/2019 | Serial | 008 |
| Patient Name | Mrs. NURJAHAN BEGUM | Contact No | NOT GIVEN |
| Address | G.T. ROAD SEORAPHULI | Age | 62 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||