Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 03124 | Date 21/01/2019 |
| Token No | SM/18-19/7228 21/01/2019 | Serial | 096 Last Visit: 21/01/2019 |
| Patient Name | Mrs. SHAHINA BEGAM | Contact No | 9883023259 |
| Address | 32A TC GOSWAMI STREET | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 69 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||