Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04189 | Date 12/03/2019 |
| Token No | SM/18-19/10468 12/03/2019 | Serial | 059 Last Visit: 27/06/2019 |
| Patient Name | Mrs. SHANKARI KAYAL | Contact No | |
| Address | CHATRA TETUL TALA GODAR BAGAN , BAIDYABATI(M) | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 67.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||