Ticket for Outdoor Patient
| Ward No. 20 | U-PHC No. | Registration No. 06420 | Date 21/07/2022 |
| Token No | SM/22-23/3948 21/07/2022 | Serial | 003 |
| Patient Name | Mrs. SULATA SWAIN | Contact No | NOT GIVEN |
| Address | 130 KHATIR BAZAR | Age | 56 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||