Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 02694 | Date 27/12/2018 |
| Token No | SM/18-19/5795 27/12/2018 | Serial | 053 Last Visit: 29/12/2018 |
| Patient Name | Mrs. RINA RAY | Contact No | 9143222994 |
| Address | 96 CHATRA MANNA PARA , BAIDYABATI (M) | Age | 52 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 49 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||