Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01774 | Date 30/10/2018 |
| Token No | SM/18-19/3157 30/10/2018 | Serial | 028 Last Visit: 30/10/2018 |
| Patient Name | Mrs. SRINWANTI GUIN | Contact No | |
| Address | 91 CHATRA BARUI PARA | Age | 21 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||