Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02014 | Date 02/05/2019 |
| Token No | SM/18-19/3500 02/05/2019 | Serial | 009 |
| Patient Name | Mr. SUBHANKAR JENA | Contact No | 9038801477 |
| Address | 9 NO INDIA JUTE MILL | Age | 16 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||