Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02180 | Date 28/11/2018 |
| Token No | SM/18-19/4307 28/11/2018 | Serial | 039 Last Visit: 28/11/2018 |
| Patient Name | Mrs. PRIYANKA DALAL | Contact No | |
| Address | CHATRA TETUL TALA | Age | 15 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||