Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00826 | Date 29/08/2018 |
| Token No | SM/18-19/1212 04/09/2018 | Serial | 048 Last Visit: 04/09/2018 |
| Patient Name | Mrs. SUJATA BIBI | Contact No | |
| Address | 3/A CHATRA MUSALMAN PARA | Age | 27.0 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 67 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||