Ticket for Outdoor Patient
| Ward No. 20 | U-PHC No. | Registration No. 03126 | Date 22/01/2019 |
| Token No | SM/18-19/7238 22/01/2019 | Serial | 009 Last Visit: 22/01/2019 |
| Patient Name | Mrs. PUJA HARI | Contact No | |
| Address | CHARA BAGAN BARUI PARA , BAIDYABATI(M) | Age | 18 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||