Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 00789 | Date 28/08/2018 |
| Token No | SM/18-19/11367 27/03/2019 | Serial | 071 Last Visit: 27/03/2019 |
| Patient Name | Mrs. MONIKA DAS | Contact No | 9874539870 |
| Address | 72/47 SHTLATALA CHATRA , BAIDYABATI(M) | Age | 42 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||