Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03867 | Date 26/02/2019 |
| Token No | SM/18-19/9459 26/02/2019 | Serial | 012 Last Visit: 26/02/2019 |
| Patient Name | Mr. PANCHUGOPAL DAS | Contact No | |
| Address | CHATRA 9, BARUIPARA LANE | Age | 66 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 42 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||