Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 02375 | Date 28/06/2019 |
| Token No | SM/18-19/4518 28/06/2019 | Serial | 008 |
| Patient Name | Miss TRISHA SHA | Contact No | 8777468154 |
| Address | 28/A TINBAZAR | Age | 19 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||