Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 05121 | Date 15/05/2019 |
| Token No | SM/19-20/21770 30/04/2020 | Serial | 054 Last Visit: 25/06/2020 |
| Patient Name | Other FIRST AID | Contact No | |
| Address | UPHC-II | Age | 2 Other |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||