Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04169 | Date 18/03/2021 |
| Token No | SM/21-22/63 07/04/2021 | Serial | 015 |
| Patient Name | Mrs. GOURI SWAIN | Contact No | |
| Address | Age | 36 YRS Female | |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||