Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00713 | Date 14/09/2018 |
| Token No | SM/18-19/951 14/09/2018 | Serial | 003 |
| Patient Name | Miss SUNITA BISWAL | Contact No | 8981419490 |
| Address | 48 N L BHATTACHARYA STREET | Age | 23 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||