Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01991 | Date 15/11/2018 |
| Token No | SM/18-19/3757 15/11/2018 | Serial | 052 Last Visit: 15/11/2018 |
| Patient Name | Mrs. JK SHAW | Contact No | |
| Address | G T ROARD | Age | 35 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||