Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 02347 | Date 25/06/2019 |
| Token No | SM/18-19/4426 25/06/2019 | Serial | 014 |
| Patient Name | Mrs. SHYAMOLI BAG | Contact No | 9062090277 |
| Address | 118 J.T.ROAD MANIK TALA | Age | 26 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||