Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04453 | Date 28/03/2019 |
| Token No | SM/18-19/11546 29/03/2019 | Serial | 054 Last Visit: 30/03/2019 |
| Patient Name | Mrs. PUSPA RANI BURMAN | Contact No | 8276070518 |
| Address | CHATRA BAGER BAGAN, BAIDYABATI(M) | Age | 36 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 75 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||