Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00020 | Date 03/08/2018 |
| Token No | SM/18-19/217 17/08/2018 | Serial | 021 |
| Patient Name | Mrs. KUNNI SWAIN | Contact No | |
| Address | DEY STREET | Age | 50 Female |
| Token For | Medicine, | Charge | Free |
| B.P | 140/70 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||