Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01620 | Date 11/10/2018 |
| Token No | SM/18-19/2760 11/10/2018 | Serial | 023 Last Visit: 11/10/2018 |
| Patient Name | Mrs. SIMA GUIN | Contact No | |
| Address | CHATRA DUTTA PARA | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||