Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01414 | Date 29/09/2018 |
| Token No | SM/18-19/2358 03/10/2018 | Serial | 013 Last Visit: 03/10/2018 |
| Patient Name | Mrs. MOUMITA SHAHA | Contact No | 9123015343 |
| Address | 12 A/1 GOALA PARA LANE | Age | 22 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||