Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02508 | Date 13/12/2018 |
| Token No | SM/18-19/5189 13/12/2018 | Serial | 036 Last Visit: 13/12/2018 |
| Patient Name | Mrs. SHIPRA DAS | Contact No | 9143695677 |
| Address | CHATRA BHAGHER BAGAN | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 72 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||