Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 02318 | Date 04/12/2018 |
| Token No | SM/18-19/4620 04/12/2018 | Serial | 006 Last Visit: 04/12/2018 |
| Patient Name | Mrs. MAYA GHORUI | Contact No | |
| Address | 102 G T ROAD, | Age | 60 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 57 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||