Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 04256 | Date 16/03/2019 |
| Token No | SM/18-19/10663 16/03/2019 | Serial | 045 Last Visit: 16/03/2019 |
| Patient Name | Mrs. RITIKA MODAK | Contact No | 7719343442 |
| Address | 17 CHATRA DUTTA PARA SERAMPORE | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||