Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 00167 | Date 06/08/2018 |
| Token No | SM/18-19/4979 10/12/2018 | Serial | 027 Last Visit: 25/02/2019 |
| Patient Name | Mrs. SHANTILATA GHOSH | Contact No | |
| Address | 15, CHAPA TALA LANE , CHATRA | Age | 86 Years,5 Months,5 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||