Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 02774 | Date 31/12/2018 |
| Token No | SM/18-19/7183 21/01/2019 | Serial | 051 Last Visit: 05/12/2019 |
| Patient Name | Mrs. MEHERJAN BIBI | Contact No | 8100524530 |
| Address | 28 CHILEKHANA ROAD | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||