Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04788 | Date 20/04/2019 |
| Token No | SM/19-20/2102 03/05/2019 | Serial | 006 Last Visit: 03/05/2019 |
| Patient Name | Miss MADHUMITA METE | Contact No | 7596898455 |
| Address | JAGATNATH PUR BAMUNARI RISHRA (M) | Age | 21 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 56 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||