Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02117 | Date 26/11/2018 |
| Token No | SM/18-19/5553 21/12/2018 | Serial | 003 Last Visit: 20/05/2019 |
| Patient Name | Mrs. RATNA DUTTA | Contact No | 9748023687 |
| Address | CHATRA TETULTALA MANIK GHOSER BAGAN | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 43 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||