Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01118 | Date 13/09/2018 |
| Token No | SM/18-19/1630 13/09/2018 | Serial | 053 Last Visit: 13/09/2018 |
| Patient Name | Mrs. RIMPA RUI DAS | Contact No | |
| Address | BAGER BAGAN TELI PARA | Age | 8.6 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 20 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||