Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02075 | Date 22/11/2018 |
| Token No | SM/18-19/4327 28/11/2018 | Serial | 059 Last Visit: 28/11/2018 |
| Patient Name | Mrs. SHAMPA RAY | Contact No | 7278056813 |
| Address | 21, CHATRA GHOSH PARA | Age | 39 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 59 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||