Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04036 | Date 22/09/2020 |
| Token No | SM/19-20/8895 22/09/2020 | Serial | 006 |
| Patient Name | Mrs. SWAPNA DEBI | Contact No | NOT GIVEN |
| Address | INDIA JUTE MILL | Age | 22 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||