Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02794 | Date 02/01/2019 |
| Token No | SM/18-19/6162 02/01/2019 | Serial | 071 Last Visit: 19/01/2019 |
| Patient Name | Mr. DIPAK DAS | Contact No | 9432383175 |
| Address | 17, P.N.K.B. LANE, CHATRA | Age | 40 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||