Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02321 | Date 20/06/2019 |
| Token No | SM/18-19/4317 20/06/2019 | Serial | 003 |
| Patient Name | Mr. MONOJ KUMAR PATTANAYAK | Contact No | 9051659033 |
| Address | 11 DOSTI LANE | Age | 23 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||