Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03360 | Date 14/11/2019 |
| Token No | SM/19-20/7674 26/11/2019 | Serial | 003 |
| Patient Name | Mr. PARSURAM SAHOO | Contact No | 6290390623 |
| Address | 11 NO LINE RAM SITA LANE | Age | 48 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||