Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 01786 | Date 30/10/2018 |
| Token No | SM/19-20/9476 30/08/2019 | Serial | 048 Last Visit: 03/09/2019 |
| Patient Name | Miss PUJA DAS | Contact No | 9874530525 |
| Address | 57/A PATUA PARA LANE | Age | 21 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||