Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04912 | Date 25/04/2019 |
| Token No | SM/20-21/29554 20/01/2021 | Serial | 002 Last Visit: 10/03/2021 |
| Patient Name | Mrs. DALEMABA JENA | Contact No | |
| Address | BAGER BAGAN TELIPARA, BAIDYABATI (M) | Age | 48 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||