Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 00481 | Date 29/11/2019 |
| Token No | SM/19-20/914 29/11/2019 | Serial | 019 |
| Patient Name | Mrs. PACHALI NAYEK | Contact No | |
| Address | PROVASNAGER | Age | 28 Female |
| Token For | Visit Doctor,Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||