Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03068 | Date 18/01/2019 |
| Token No | SM/18-19/7576 30/01/2019 | Serial | 006 Last Visit: 30/05/2019 |
| Patient Name | Mrs. JHUMA DAS | Contact No | 9874444550 |
| Address | 3/C CHATRA GHOSH PARA | Age | 35 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 74 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||