Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02520 | Date 19/07/2019 |
| Token No | SM/18-19/4897 19/07/2019 | Serial | 032 |
| Patient Name | Miss PUJA SWAIN | Contact No | 8617713091 |
| Address | 12 PITAMBAR DEY LANE | Age | 17 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||