Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03081 | Date 19/09/2019 |
| Token No | SM/18-19/6572 19/09/2019 | Serial | 032 |
| Patient Name | Mrs. SURAIYA BEGUM | Contact No | |
| Address | DEY STREET | Age | 48 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||