Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02744 | Date 06/08/2019 |
| Token No | SM/18-19/5464 06/08/2019 | Serial | 043 |
| Patient Name | Miss ANJALI SHA | Contact No | 9339646969 |
| Address | 6 NAYA BAGAN RAM SITA LANE | Age | 19 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||