Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03225 | Date 18/10/2019 |
| Token No | SM/18-19/7001 18/10/2019 | Serial | 026 |
| Patient Name | Mrs. BULA KOIRI | Contact No | 8961451363 |
| Address | 8 ACHARYA K C BHATTACHARYA STREET | Age | 52 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||