Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02679 | Date 24/12/2018 |
| Token No | SM/18-19/5736 24/12/2018 | Serial | 059 Last Visit: 28/12/2018 |
| Patient Name | Mrs. GITA GUJRATI | Contact No | 7044686250 |
| Address | BENGAL FINE MORE KONNGAR (M) | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 37 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||