Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01767 | Date 29/10/2018 |
| Token No | SM/18-19/3129 29/10/2018 | Serial | 101 Last Visit: 29/10/2018 |
| Patient Name | Mrs. ALPANA PAL | Contact No | 9163000427 |
| Address | CHATRA TETUL TALA BAJAR | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 34 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||