Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02481 | Date 12/12/2018 |
| Token No | SM/18-19/5122 12/12/2018 | Serial | 036 Last Visit: 12/12/2018 |
| Patient Name | Miss FALAKNASH KHATUN | Contact No | 6289106294 |
| Address | BOROBELU KOLTALA | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | 110/70 mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||