Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02611 | Date 20/12/2018 |
| Token No | SM/18-19/9218 21/02/2019 | Serial | 080 Last Visit: 12/03/2019 |
| Patient Name | Mrs. JULEHA BIBI | Contact No | 8820217073 |
| Address | 7/D ARBINDA SARANI CHATRA | Age | 24 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 41 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||