Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03054 | Date 17/01/2019 |
| Token No | SM/18-19/6992 17/01/2019 | Serial | 072 Last Visit: 17/01/2019 |
| Patient Name | Mrs. BABY BIBI | Contact No | 7890701775 |
| Address | 5/A MUSALMAN PARA, CHATRA | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | 80/60 mmHg | Weight | 38 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||