Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01939 | Date 12/11/2018 |
| Token No | SM/18-19/3605 12/11/2018 | Serial | 083 Last Visit: 12/11/2018 |
| Patient Name | Mrs. GULAPSHA BEGAM | Contact No | 6290327070 |
| Address | CHATRA MUSALMAN PARA | Age | 20 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 38 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||