Ticket for Outdoor Patient
| Ward No. 7 | U-PHC No. | Registration No. 03150 | Date 24/01/2019 |
| Token No | SM/18-19/7315 24/01/2019 | Serial | 002 Last Visit: 24/01/2019 |
| Patient Name | Mrs. CHANDRAPATI DOLUI | Contact No | |
| Address | 13 N.N RAY STREET | Age | 65 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 57 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||