Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03996 | Date 12/08/2020 |
| Token No | SM/19-20/8825 12/08/2020 | Serial | 007 |
| Patient Name | Mrs. SUSHMA DEBI KOIRI | Contact No | 7278869737 |
| Address | 79 DEY STREET | Age | 30 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||