Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00964 | Date 25/09/2018 |
| Token No | SM/18-19/1250 25/09/2018 | Serial | 012 |
| Patient Name | Mr. SUBHANKAR JENA | Contact No | 9038152053 |
| Address | 9/438 INDIA JUTE MILL LINE | Age | 15 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||