Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02571 | Date 18/12/2018 |
| Token No | SM/18-19/5395 18/12/2018 | Serial | 004 Last Visit: 04/01/2023 |
| Patient Name | Miss PIYA DAS | Contact No | 9038485220 |
| Address | 65 CHATRA LANKAR BAGAN | Age | 16 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||