Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 00418 | Date 14/08/2018 |
| Token No | SM/18-19/5870 28/12/2018 | Serial | 012 Last Visit: 10/06/2019 |
| Patient Name | Mrs. ALO DAS MONDAL | Contact No | 9830934789 |
| Address | 44, KUMIRJOLA ROAD | Age | 67 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 30 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||