Ticket for Outdoor Patient
| Ward No. 7 | U-PHC No. | Registration No. 00841 | Date 30/08/2018 |
| Token No | SM/18-19/1066 30/08/2018 | Serial | 020 Last Visit: 30/08/2018 |
| Patient Name | Mrs. NUPUR MODAK | Contact No | |
| Address | 2, N.N ROY STREET | Age | 24.0 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||