Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03189 | Date 15/10/2019 |
| Token No | SM/18-19/6919 15/10/2019 | Serial | 011 |
| Patient Name | Mrs. SANJU GHARAI | Contact No | 8981983080 |
| Address | 12/568 COCKRAIN ROAD | Age | 43 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||