Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 02658 | Date 30/07/2019 |
| Token No | SM/18-19/5256 30/07/2019 | Serial | 021 |
| Patient Name | Mrs. KABITA SHASMAL | Contact No | NOT GIVEN |
| Address | 40A/1 BHAGIRATHI LANE | Age | 30 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||