Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 00158 | Date 06/08/2018 |
| Token No | SM/19-20/25480 05/09/2020 | Serial | 011 Last Visit: 06/12/2025 |
| Patient Name | Mrs. PADMABATI MODAK | Contact No | 8100837190 |
| Address | 134/A BARUI PARA LANE , CHATRA | Age | 75 Years,11 Months,4 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||