Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01724 | Date 27/10/2018 |
| Token No | SM/18-19/9292 22/02/2019 | Serial | 069 Last Visit: 11/04/2019 |
| Patient Name | Mrs. SULEKHA BISWASH | Contact No | 8013216584 |
| Address | CHATRA POMPA NAGAR | Age | 36 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||