Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03481 | Date 26/11/2019 |
| Token No | SM/19-20/7679 26/11/2019 | Serial | 008 |
| Patient Name | Mr. SURENDAR SWAIN | Contact No | NOT GIVEN |
| Address | 14/B DEY STREET | Age | 63 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||