Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 00187 | Date 07/08/2018 |
| Token No | SM/18-19/11618 30/03/2019 | Serial | 033 Last Visit: 30/03/2019 |
| Patient Name | Mrs. SUJATA BAG | Contact No | 9831209640 |
| Address | BAGER BAGAN, CHATRA | Age | 42 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||