Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03004 | Date 14/01/2019 |
| Token No | SM/18-19/7722 31/01/2019 | Serial | 096 Last Visit: 12/02/2019 |
| Patient Name | Mrs. DOLLY SINHA | Contact No | |
| Address | 29E CHATRA LAHIRI PARA | Age | 58 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 36 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||