Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 05103 | Date 14/05/2019 |
| Token No | SM/19-20/4596 14/06/2019 | Serial | 071 Last Visit: 14/06/2019 |
| Patient Name | Mrs. SHYAMALI MAJHI | Contact No | 9038710514 |
| Address | 129/15/D/B SATCHASI PARA , BAIDYABTI(M) | Age | 47 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||