Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01485 | Date 03/10/2018 |
| Token No | SM/25-26/8126 19/11/2025 | Serial | 032 Last Visit: 19/11/2025 |
| Patient Name | Mrs. RAJESWARI MODAK | Contact No | 9231894209 |
| Address | 134A BARUI PARA CHATRA | Age | 39 Years,10 Months,17 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||