Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03178 | Date 25/01/2019 |
| Token No | SM/18-19/7426 25/01/2019 | Serial | 016 Last Visit: 30/01/2019 |
| Patient Name | Mrs. NILIMA DAS | Contact No | 7449863649 |
| Address | 16, CHAPATALA LANE CHATRA | Age | 38 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 59 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||