Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02192 | Date 29/11/2018 |
| Token No | SM/18-19/4341 29/11/2018 | Serial | 002 Last Visit: 29/11/2018 |
| Patient Name | Miss SANCHIAITA CHOWDHURY | Contact No | 9123965920 |
| Address | 62/A GT ROAD CHATRA TETUL TALA , BAIDYABATI (M) | Age | 23 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||