Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02532 | Date 22/07/2019 |
| Token No | SM/18-19/4928 22/07/2019 | Serial | 021 |
| Patient Name | Mr. ASIM PATRA | Contact No | 9332075920 |
| Address | SIRISH TALA | Age | 46 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||