Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01051 | Date 11/09/2018 |
| Token No | SM/18-19/4292 28/11/2018 | Serial | 024 Last Visit: 16/04/2020 |
| Patient Name | Mrs. RABINA SOMANI | Contact No | 8910832877 |
| Address | 10/Z/A/A CHATRA GOADAR BAGAN BYE LANE BAIDYABATI (M) | Age | 23 yrs Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||