Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01941 | Date 12/11/2018 |
| Token No | SM/18-19/3609 12/11/2018 | Serial | 087 Last Visit: 12/11/2018 |
| Patient Name | Mrs. RUPALI PATRA | Contact No | 9874945349 |
| Address | 6/2 BEBEKANENDU LANE | Age | 47 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||