Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 00691 | Date 25/08/2018 |
| Token No | SM/18-19/847 25/08/2018 | Serial | 016 Last Visit: 27/12/2019 |
| Patient Name | Miss UPASANA PATRA | Contact No | 9331557379 |
| Address | 21, CHATRA BAZAR ROAD | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 17 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||