Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05430 | Date 14/06/2019 |
| Token No | SM/19-20/4561 14/06/2019 | Serial | 036 Last Visit: 22/06/2019 |
| Patient Name | Mr. DILIP PAL CHEENA | Contact No | 9674357914 |
| Address | 12/G/2 ARABINDA SARANI | Age | 72 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 70 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||