Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03178 | Date 14/10/2019 |
| Token No | SM/18-19/6893 14/10/2019 | Serial | 009 |
| Patient Name | Mrs. DHANI JENA | Contact No | 9038801477 |
| Address | 438/9 INDIA JUTE MILL | Age | 80 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||