Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00269 | Date 11/08/2018 |
| Token No | SM/18-19/3016 02/04/2019 | Serial | 026 |
| Patient Name | Mrs. MANJU PRADHAN | Contact No | 9681660305 |
| Address | 9 INDIA JUTE MILL | Age | 56 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||