Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01946 | Date 14/11/2018 |
| Token No | SM/18-19/3621 14/11/2018 | Serial | 010 Last Visit: 14/11/2018 |
| Patient Name | Mrs. JABA ROY | Contact No | 7685001997 |
| Address | CHATRA BAGHER BAGAN | Age | 21 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 48 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||