Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03684 | Date 18/02/2019 |
| Token No | SM/18-19/8966 18/02/2019 | Serial | 139 Last Visit: 18/03/2019 |
| Patient Name | Mrs. TAPASHI SOM | Contact No | 9830679114 |
| Address | 19A CHATRA BARUI PARA LANE | Age | 58 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||