Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02868 | Date 07/01/2019 |
| Token No | SM/18-19/6400 07/01/2019 | Serial | 054 Last Visit: 07/11/2019 |
| Patient Name | Mrs. MUMTAJ BIBI | Contact No | |
| Address | 12 CHATRA MUSALMAN PARA SERAMPORE | Age | 30 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||