Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 09963 | Date 19/08/2021 |
| Token No | SM/21-22/4210 19/08/2021 | Serial | 016 Last Visit: 19/08/2021 |
| Patient Name | Mrs. SULATA SOM | Contact No | 9883730539 |
| Address | 68/A BARUIPARA LANE | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||