Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00200 | Date 07/08/2018 |
| Token No | SM/18-19/208 07/08/2018 | Serial | 023 Last Visit: 13/08/2018 |
| Patient Name | Mrs. ALPANA SOM | Contact No | 7890842026 |
| Address | 123 BARUIPARA LANE, CHATRA | Age | 48.0 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||