Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03157 | Date 01/10/2019 |
| Token No | SM/18-19/6832 01/10/2019 | Serial | 022 |
| Patient Name | Mrs. PIU ADHIKARY | Contact No | 9062869507 |
| Address | 9/B PATUA PARA | Age | 29 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||