Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02654 | Date 30/07/2019 |
| Token No | SM/18-19/5241 30/07/2019 | Serial | 006 |
| Patient Name | Miss MAHIMA PARIDA | Contact No | 6291304919 |
| Address | 9/488 INDIA JUTE MILL | Age | 20 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||