Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05437 | Date 14/06/2019 |
| Token No | SM/19-20/4602 14/06/2019 | Serial | 077 Last Visit: 14/06/2019 |
| Patient Name | Miss MAMPI BISWES | Contact No | 9874146909 |
| Address | PEYARAP[UR SEORAPHULY | Age | 16 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||