Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 00440 | Date 25/11/2019 |
| Token No | SM/19-20/1198 20/12/2019 | Serial | 014 |
| Patient Name | Mr. MODAN MOHAN PATRA | Contact No | 8017087267 |
| Address | 19 SANI PARA BY LANE SERAMPORE 712203 | Age | 80 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||