Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02663 | Date 24/12/2018 |
| Token No | SM/18-19/6766 14/01/2019 | Serial | 057 Last Visit: 12/12/2019 |
| Patient Name | Mrs. MIRA DAS | Contact No | 9933629675 |
| Address | CHOKONON,HARIPAL | Age | 52 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||