Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02175 | Date 28/11/2018 |
| Token No | SM/18-19/4685 05/12/2018 | Serial | 009 Last Visit: 05/12/2018 |
| Patient Name | Mrs. BELA MONDAL | Contact No | 8820487308 |
| Address | BAGER BAGAN , BAIDYABATI (M) | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 43.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||