Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 04632 | Date 08/04/2019 |
| Token No | SM/19-20/545 08/04/2019 | Serial | 109 Last Visit: 08/04/2019 |
| Patient Name | Mrs. MOHONA RAM | Contact No | 9163098867 |
| Address | SHITALATALA ROAD BAIDYABATI(M) CHATRA | Age | 10 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 34 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||