Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02585 | Date 18/12/2018 |
| Token No | SM/19-20/8234 09/08/2019 | Serial | 041 Last Visit: 09/08/2019 |
| Patient Name | Mrs. DURGA GAYEN | Contact No | |
| Address | 123 CHARA LANKER BAGAN, | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||