Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04384 | Date 25/03/2019 |
| Token No | SM/18-19/11202 25/03/2019 | Serial | 122 Last Visit: 25/03/2019 |
| Patient Name | Mrs. CHAMPA GHOSH | Contact No | 9339665040 |
| Address | CHATRA TELI PARA , BAIDYABATI(M) | Age | 32 yrs Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 70 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||