Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00714 | Date 14/09/2018 |
| Token No | SM/18-19/1532 12/10/2018 | Serial | 005 |
| Patient Name | Mrs. SUREKHA BISWAL | Contact No | 8981419490 |
| Address | 45 N. L BHATTACHARYA STREET | Age | 90 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||