Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 02223 | Date 29/11/2018 |
| Token No | SM/18-19/4722 05/12/2018 | Serial | 046 Last Visit: 23/02/2019 |
| Patient Name | Mrs. PADMA RANI DHAR | Contact No | |
| Address | SEORAPHULY, MALLICK BAGAN | Age | 55 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 57 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||