Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 01596 | Date 22/01/2019 |
| Token No | SM/18-19/4116 13/06/2019 | Serial | 006 |
| Patient Name | Mrs. SALINI SHA | Contact No | 8420775014 |
| Address | 28/A TIN BAZAR BYE LANE | Age | 25 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||