Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00227 | Date 25/08/2018 |
| Token No | SM/19-20/8038 13/12/2019 | Serial | 011 |
| Patient Name | Mrs. JAMUNA SWAIN | Contact No | NOT GIVEN |
| Address | INDIA JUTE MILL | Age | 60 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 47 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||