Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01775 | Date 10/03/2019 |
| Token No | SM/18-19/2763 10/03/2019 | Serial | 005 |
| Patient Name | Mrs. SOMA PATRA | Contact No | 8336949029 |
| Address | 11 ANNADA BABU GARDEN LANE | Age | 24 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||