Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01592 | Date 09/10/2018 |
| Token No | SM/18-19/2717 10/10/2018 | Serial | 042 Last Visit: 26/11/2018 |
| Patient Name | Mr. DILIP KARAK | Contact No | 8481870261 |
| Address | 509,CHATRA GT ROAD JAL TANK | Age | 55 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||