Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 02722 | Date 28/12/2018 |
| Token No | SM/19-20/14173 27/11/2019 | Serial | 082 Last Visit: 26/11/2025 |
| Patient Name | Mrs. KANCHAN LAHA | Contact No | |
| Address | CHATRA SHITLATALA | Age | 22 Years,10 Months,25 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 41 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||