Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 02465 | Date 11/12/2018 |
| Token No | SM/18-19/5057 11/12/2018 | Serial | 037 Last Visit: 05/01/2019 |
| Patient Name | Mrs. BASANTI PAL | Contact No | |
| Address | CHATRA TETUL TALA BAZAR | Age | 58 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 49 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||