Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01977 | Date 15/11/2018 |
| Token No | SM/18-19/3724 15/11/2018 | Serial | 019 Last Visit: 15/11/2018 |
| Patient Name | Mrs. SHAMALY GHSOH | Contact No | 9939246622 |
| Address | CHATRA SHITLATALA , BAIDYABATI (M) | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||