Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 04387 | Date 26/03/2019 |
| Token No | SM/18-19/11218 26/03/2019 | Serial | 011 Last Visit: 26/03/2019 |
| Patient Name | Mrs. PRIYANKA POLEY | Contact No | 8100819799 |
| Address | 17 CHAKRABORTY LANE SERAMPORE | Age | 17 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||