Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01640 | Date 12/02/2019 |
| Token No | SM/18-19/4049 10/06/2019 | Serial | 017 |
| Patient Name | Mrs. RINKI KOIRI | Contact No | 9038125322 |
| Address | 79 DEY STREET | Age | 24 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||