Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01770 | Date 30/10/2018 |
| Token No | SM/18-19/3391 03/11/2018 | Serial | 004 Last Visit: 28/07/2020 |
| Patient Name | Miss MOUSUMI SOM | Contact No | 8478970398 |
| Address | 124/C CHATRA BARUI PARA | Age | 28 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||