Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01695 | Date 27/10/2018 |
| Token No | SM/18-19/6653 11/01/2019 | Serial | 010 Last Visit: 01/06/2019 |
| Patient Name | Miss MOUMITA CHOWDHURY | Contact No | 26528691 |
| Address | 10/C RAI M .C LAHIRI BAHADUR STREET | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||