Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00664 | Date 04/01/2020 |
| Token No | SM/19-20/1397 04/01/2020 | Serial | 019 |
| Patient Name | Mrs. MALATI DHARA | Contact No | |
| Address | BORA FOTKE | Age | 45 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | 56 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||