Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03902 | Date 27/02/2019 |
| Token No | SM/18-19/10196 08/03/2019 | Serial | 087 Last Visit: 08/03/2019 |
| Patient Name | Miss PRIYANKA BARIK | Contact No | 9051746622 |
| Address | CHOTO BELUR CHECK POST | Age | 14 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||