Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02193 | Date 29/11/2018 |
| Token No | SM/18-19/6227 04/01/2019 | Serial | 012 Last Visit: 04/01/2019 |
| Patient Name | Mrs. SHAMPA CHOWDHURY | Contact No | 9123965920 |
| Address | 62/A GT ROAD CHATRA TETUL TALA , BAIDYABATI (M) | Age | 42 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||