Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02060 | Date 20/11/2018 |
| Token No | SM/18-19/3979 20/11/2018 | Serial | 057 Last Visit: 25/02/2019 |
| Patient Name | Mrs. RIMPA SOM | Contact No | 8478902520 |
| Address | 19B , CHATRA BARUI PARA LANE | Age | 20 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||