Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05083 | Date 13/05/2019 |
| Token No | SM/19-20/2607 13/05/2019 | Serial | 018 Last Visit: 13/05/2019 |
| Patient Name | Mrs. PAMPA SAMANTA | Contact No | 8268878717 |
| Address | SIGUR GOBINDA | Age | 30 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 75 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||