Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01742 | Date 29/10/2018 |
| Token No | SM/18-19/5799 27/12/2018 | Serial | 057 Last Visit: 27/12/2018 |
| Patient Name | Mrs. RUPALI PAL | Contact No | 8931573538 |
| Address | 146, G.T ROAD CHATRA BOU BAJAR, BAIDYABATI (M) | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||