Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 02797 | Date 13/08/2019 |
| Token No | SM/18-19/5596 13/08/2019 | Serial | 021 |
| Patient Name | Miss PIU PATRA | Contact No | 8033694902 |
| Address | 11 A B GARDEN LANE | Age | 13 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||