Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00965 | Date 25/09/2018 |
| Token No | SM/18-19/1251 25/09/2018 | Serial | 013 |
| Patient Name | Master RANBIR JENA | Contact No | 9038152053 |
| Address | 9/438 INDIA JUTYE MILL | Age | 10 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||