Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02662 | Date 24/12/2018 |
| Token No | SM/18-19/5679 24/12/2018 | Serial | 002 Last Visit: 27/12/2018 |
| Patient Name | Mr. SUDIPTA DAS | Contact No | 9933629675 |
| Address | CHOKONANTO,HORIPAL | Age | 10 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||