Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03095 | Date 23/09/2019 |
| Token No | SM/18-19/6962 17/10/2019 | Serial | 023 |
| Patient Name | Mrs. SONI DEBI KOIRI | Contact No | 8820981498 |
| Address | 79 DEY STREET | Age | 27 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||