Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01570 | Date 11/01/2019 |
| Token No | SM/18-19/2267 11/01/2019 | Serial | 019 |
| Patient Name | Mrs. SAROJINI BISWAL | Contact No | NOT GIVEN |
| Address | 45 N.L BHATTACHARYA ST | Age | 36 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||