Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01949 | Date 14/11/2018 |
| Token No | SM/18-19/3626 14/11/2018 | Serial | 015 Last Visit: 14/11/2018 |
| Patient Name | Mrs. BASANTI MALLICK | Contact No | |
| Address | 39 A P GHOSH ROAD | Age | 35 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 69 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||