Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 00163 | Date 06/08/2018 |
| Token No | SM/18-19/2051 25/09/2018 | Serial | 033 Last Visit: 09/10/2018 |
| Patient Name | Mrs. KAKOLI GHOSH | Contact No | 9007869256 |
| Address | 33, CHAKRABORTY LANE | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||