Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01386 | Date 27/09/2018 |
| Token No | SM/18-19/2158 27/09/2018 | Serial | 039 Last Visit: 27/09/2018 |
| Patient Name | Mrs. TINA PAJA | Contact No | |
| Address | CHATRA LANKAR BAGAN | Age | 14 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 46 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||