Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03106 | Date 23/09/2019 |
| Token No | SM/18-19/6642 23/09/2019 | Serial | 044 |
| Patient Name | Mrs. BELA PARIDA | Contact No | NOT GIVEN |
| Address | DEY STREET | Age | 41 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||