Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 01885 | Date 03/11/2018 |
| Token No | SM/18-19/3438 03/11/2018 | Serial | 051 Last Visit: 03/11/2018 |
| Patient Name | Mrs. DHANPATI SHAW | Contact No | |
| Address | 13, PACHU GOPAL BHADURI SARANI SERAMPORE | Age | 70 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 44 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||