Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 00612 | Date 21/08/2018 |
| Token No | SM/18-19/1030 29/08/2018 | Serial | 036 Last Visit: 29/08/2018 |
| Patient Name | Mrs. MAHAMAYA DAS | Contact No | 9674256958 |
| Address | 26, DHARMOTALA , CHATRA | Age | 80.0 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||