Ticket for Outdoor Patient
| Ward No. 20 | U-PHC No. | Registration No. 04246 | Date 16/03/2019 |
| Token No | SM/18-19/10632 16/03/2019 | Serial | 014 Last Visit: 26/03/2019 |
| Patient Name | Mrs. KAJAL DEVI PADAR | Contact No | 8420478872 |
| Address | SHEWRAPHULI BAURI PARA RAMKRISHNA ROAD, BAIDYABATI(M) | Age | 18 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||