Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 02612 | Date 20/12/2018 |
| Token No | SM/18-19/5533 20/12/2018 | Serial | 046 Last Visit: 07/03/2019 |
| Patient Name | Mrs. SHANKARI DAS | Contact No | 9874047551 |
| Address | CHATRA SHITLATALA , BAIDYABATI(M) | Age | 86 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||