Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 04835 | Date 31/08/2021 |
| Token No | SM/21-22/1003 31/08/2021 | Serial | 025 |
| Patient Name | Mr. HIRA SASMAL | Contact No | 8585805310 |
| Address | 40/A BHAGIRATHI LANE | Age | 35 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||