Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05160 | Date 20/05/2019 |
| Token No | SM/19-20/3021 20/05/2019 | Serial | 069 Last Visit: 19/04/2021 |
| Patient Name | Mrs. RENUKA DAS | Contact No | 7890551091 |
| Address | 36/A G.T ROAD CHATRA BAIDYABATI | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||