Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02330 | Date 04/12/2018 |
| Token No | SM/18-19/6489 08/01/2019 | Serial | 043 Last Visit: 02/04/2020 |
| Patient Name | Mrs. PURNIMA BARIK | Contact No | 8481824984 |
| Address | CHATRA SITALATALA G T ROAD | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||