Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 04122 | Date 09/03/2019 |
| Token No | SM/18-19/10259 09/03/2019 | Serial | 050 Last Visit: 09/03/2019 |
| Patient Name | Mrs. ANTARA PAKIRA SOM | Contact No | 8697147350 |
| Address | 55 CHATRA DHARMOTALA SERAMPORE | Age | 32 yrs Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 58 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||