Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 02732 | Date 29/12/2018 |
| Token No | SM/18-19/5961 29/12/2018 | Serial | 016 Last Visit: 05/01/2019 |
| Patient Name | Mrs. DIPIKA DE | Contact No | 6290689711 |
| Address | 48/4/B PATUA PARA LANE | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||