Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01286 | Date 24/09/2018 |
| Token No | SM/18-19/2021 25/09/2018 | Serial | 003 Last Visit: 27/09/2018 |
| Patient Name | Mr. MURARI MOHON DAS | Contact No | 9903169467 |
| Address | 20 KUMIR JELA ROAD | Age | 66 YRS Male |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||