Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02128 | Date 26/11/2018 |
| Token No | SM/20-21/30688 13/03/2021 | Serial | 027 Last Visit: 18/12/2025 |
| Patient Name | Mrs. CHAYA PALCHEENA | Contact No | 9674357914 |
| Address | 12 G/2 ARABINDA SARANI CHATRA KUMOR PARA | Age | 69 Years,11 Months,14 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||