Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02136 | Date 28/05/2019 |
| Token No | SM/18-19/3950 04/06/2019 | Serial | 005 |
| Patient Name | Mr. SATYABAN BARIK | Contact No | NOT GIVEN |
| Address | 9 RAM SITA LANE | Age | 44 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||