Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05852 | Date 19/07/2019 |
| Token No | SM/19-20/7317 25/07/2019 | Serial | 070 Last Visit: 02/08/2019 |
| Patient Name | Mrs. MOMOTA HENA BEGUM | Contact No | 9674253720 |
| Address | 3 CHATRA MUSALMAN PARA LANE | Age | 30 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 73 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||