Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01219 | Date 19/09/2018 |
| Token No | SM/18-19/1851 20/09/2018 | Serial | 002 Last Visit: 15/11/2018 |
| Patient Name | Mrs. SIBANI DEY | Contact No | 8100785038 |
| Address | CHATRA MAIK GHOSER BAGAN , BAIDYABATI | Age | 44 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||