Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 04395 | Date 26/03/2019 |
| Token No | SM/18-19/11235 26/03/2019 | Serial | 028 Last Visit: 06/04/2019 |
| Patient Name | Mrs. BULTI RAM | Contact No | 8274900535 |
| Address | CHATRA TETULTALA BAIDYABATI(M) | Age | 23 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 39 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||