Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03742 | Date 15/01/2020 |
| Token No | SM/19-20/8396 15/01/2020 | Serial | 001 |
| Patient Name | Mrs. KUNI SWAIN | Contact No | 6289672969 |
| Address | 8 NO LINE | Age | 51 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 59 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||