Ticket for Outdoor Patient
| Ward No. 16 | U-PHC No. | Registration No. 03418 | Date 18/11/2019 |
| Token No | SM/18-19/7481 18/11/2019 | Serial | 023 |
| Patient Name | Mrs. LAXMI NAYEK | Contact No | NOT GIVEN |
| Address | 17 J N LAHIRI ROAD | Age | 22 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||