Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02870 | Date 22/08/2019 |
| Token No | SM/18-19/5823 22/08/2019 | Serial | 001 |
| Patient Name | Mrs. RADHA RAJBHAR | Contact No | NOT GIVEN |
| Address | MAHABIR SAMITI CLUB, DEY STREET | Age | 31 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||