Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03243 | Date 31/01/2019 |
| Token No | SM/18-19/7630 31/01/2019 | Serial | 004 Last Visit: 02/02/2019 |
| Patient Name | Mrs. MIRA PATRA | Contact No | |
| Address | 21 CHATRA BAZAR ROAD | Age | 60 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 69 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||