Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02822 | Date 16/08/2019 |
| Token No | SM/18-19/5680 16/08/2019 | Serial | 048 |
| Patient Name | Mrs. SAROJINI BISWAL | Contact No | 9903297336 |
| Address | 9 NO LINE, INDIA JUTE MILL | Age | 54 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||