Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04444 | Date 28/03/2019 |
| Token No | SM/18-19/11451 28/03/2019 | Serial | 053 Last Visit: 28/03/2019 |
| Patient Name | Mrs. SANCHITA RAY | Contact No | 8334913733 |
| Address | 21, GHOSH PARA 1ST LANE | Age | 20 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 58 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||