Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 04214 | Date 15/03/2019 |
| Token No | SM/18-19/10931 20/03/2019 | Serial | 036 Last Visit: 20/03/2019 |
| Patient Name | Mrs. SUSHAMA DAS | Contact No | 9007656143 |
| Address | 101 N.S AVENUE SEARMPORE | Age | 26 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||