Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03251 | Date 21/10/2019 |
| Token No | SM/18-19/7075 21/10/2019 | Serial | 042 |
| Patient Name | Miss SONA SWAIN | Contact No | 8777571794 |
| Address | 44B/5 N L BHATTACHARYA STREET | Age | 20 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||