Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 00104 | Date 07/08/2018 |
| Token No | SM/18-19/754 01/09/2018 | Serial | 010 |
| Patient Name | Mrs. KARUNA MOHANTY | Contact No | NOT GIVEN |
| Address | HOSPITAL LANE | Age | 59 Female |
| Token For | Medicine, | Charge | Free |
| B.P | 148/80 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||