Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 05580 | Date 26/06/2019 |
| Token No | SM/19-20/5365 26/06/2019 | Serial | 029 Last Visit: 26/06/2019 |
| Patient Name | Mrs. AMBIKA BHADRA DAS | Contact No | 9903482544 |
| Address | CHATRA CHOWDHURY PARA LANE | Age | 30 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||