Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02218 | Date 10/06/2019 |
| Token No | SM/18-19/4308 20/06/2019 | Serial | 011 |
| Patient Name | Mrs. KALPANA PRASAD | Contact No | 8697470982 |
| Address | BORO BELU KOLTALA | Age | 60 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||