Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04533 | Date 03/04/2019 |
| Token No | SM/19-20/8171 08/08/2019 | Serial | 036 Last Visit: 08/08/2019 |
| Patient Name | Mrs. MALTI RUI DAS | Contact No | |
| Address | CHATRA BAGER BAGAN | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||