Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01219 | Date 26/10/2018 |
| Token No | SM/18-19/1639 26/10/2018 | Serial | 007 |
| Patient Name | Mrs. SIDDHESWARI MONDAL | Contact No | 9804029062 |
| Address | 32/2 K C MUKHERJEE STREET, CHATRA | Age | 54 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||