Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00511 | Date 17/08/2018 |
| Token No | SM/18-19/580 17/08/2018 | Serial | 018 Last Visit: 20/08/2018 |
| Patient Name | Mrs. MARIYAM KHATOON | Contact No | 9007755751 |
| Address | 4/A ARBINDO SARNI , CHATRA | Age | 13.0 Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||