Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03187 | Date 25/01/2019 |
| Token No | SM/18-19/7469 25/01/2019 | Serial | 059 Last Visit: 29/04/2021 |
| Patient Name | Mr. HAMENTA PAUL | Contact No | 8583822278 |
| Address | 38 CHATRA, KUMER PARA | Age | 12 yrs Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||