Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04109 | Date 09/03/2019 |
| Token No | SM/18-19/10223 09/03/2019 | Serial | 014 Last Visit: 25/03/2019 |
| Patient Name | Mrs. SANDHA MODAK | Contact No | 9123616993 |
| Address | SANPUKUR DHAR RAMKRISHNA ROAD, BAIDYABATI(M) | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 49.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||