Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03180 | Date 14/10/2019 |
| Token No | SM/18-19/6896 14/10/2019 | Serial | 012 |
| Patient Name | Mr. GANESH NAYAK | Contact No | NOT GIVEN |
| Address | J N LAHIRI ROAD | Age | 50 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||