Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00505 | Date 20/08/2018 |
| Token No | SM/18-19/3129 08/04/2019 | Serial | 010 |
| Patient Name | Mr. SANJU PARIDA | Contact No | 9681660305 |
| Address | 9 INDIAN JUTE MILL | Age | 47 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||