Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01882 | Date 03/11/2018 |
| Token No | SM/18-19/3417 03/11/2018 | Serial | 030 Last Visit: 14/11/2018 |
| Patient Name | Mrs. GITA MALI | Contact No | |
| Address | 59 BCHATRA DHARMA TALA | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||