Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 02668 | Date 24/12/2018 |
| Token No | SM/18-19/5692 24/12/2018 | Serial | 015 Last Visit: 24/12/2018 |
| Patient Name | Mrs. SHIBANI DAS | Contact No | 8017245943 |
| Address | CHATRA TETUL TALA,BAIDYABATY(M) | Age | 65 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||