Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01756 | Date 29/10/2018 |
| Token No | SM/18-19/5720 24/12/2018 | Serial | 043 Last Visit: 07/02/2019 |
| Patient Name | Mrs. SONWARA BEGAM | Contact No | 7890759202 |
| Address | CHATRA MUSALMAN PARA | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 38 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||