Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02354 | Date 05/12/2018 |
| Token No | SM/18-19/4726 05/12/2018 | Serial | 050 Last Visit: 05/12/2018 |
| Patient Name | Mrs. MAMONI MAITY | Contact No | |
| Address | CHATRA PATTI PARA | Age | 23 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 43 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||