Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 03140 | Date 22/01/2019 |
| Token No | SM/18-19/7288 22/01/2019 | Serial | 059 Last Visit: 22/01/2019 |
| Patient Name | Mrs. JAYA DEBI | Contact No | 8420280375 |
| Address | 18 S C M ROAD,CHABDANI(M) | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||