Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03117 | Date 21/01/2019 |
| Token No | SM/18-19/7199 21/01/2019 | Serial | 067 Last Visit: 21/01/2019 |
| Patient Name | Mrs. SIPRA PAL | Contact No | 9163531210 |
| Address | CHATRA MANSA TALA, BAIDYABATI (M) | Age | 46 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||