Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 00143 | Date 06/08/2018 |
| Token No | SM/18-19/5442 19/12/2018 | Serial | 006 Last Visit: 10/06/2019 |
| Patient Name | Mrs. JASHODA GUIN | Contact No | 9836125054 |
| Address | CHATRA BARUI PARA | Age | 80 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||