Ticket for Outdoor Patient
| Ward No. 6 | U-PHC No. | Registration No. 03118 | Date 21/01/2019 |
| Token No | SM/18-19/7201 21/01/2019 | Serial | 069 Last Visit: 21/01/2019 |
| Patient Name | Mrs. SANDHYA BHAGAT | Contact No | 9674327989 |
| Address | CHELO PATTI LANE SHEWRAPHULI, BAIDYABATI(M) | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 58 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||