Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03134 | Date 27/09/2019 |
| Token No | SM/18-19/6766 27/09/2019 | Serial | 040 |
| Patient Name | Mrs. MADHUPARNA MANJHI | Contact No | 6369528925 |
| Address | 567 G.T.ROAD | Age | 40 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||