Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01681 | Date 26/10/2018 |
| Token No | SM/18-19/4462 30/11/2018 | Serial | 051 Last Visit: 30/11/2018 |
| Patient Name | Mrs. MALATI HARI | Contact No | |
| Address | CHATRA BAGER BAGAN, BAIDYABTI (M) | Age | 65 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||