Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02644 | Date 29/07/2019 |
| Token No | SM/18-19/5218 29/07/2019 | Serial | 028 |
| Patient Name | Mr. KESTO SWAIN | Contact No | |
| Address | 12NO PITAMBAR DEY LANE , DEY STREET | Age | 58 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||