Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02693 | Date 27/12/2018 |
| Token No | SM/18-19/5794 27/12/2018 | Serial | 052 Last Visit: 27/12/2018 |
| Patient Name | Mrs. SUSHMITA GHOSH | Contact No | 8013074102 |
| Address | 66 CHATRA DHARMOTALA LANE | Age | 23 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 56 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||