Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03067 | Date 18/01/2019 |
| Token No | SM/18-19/7577 30/01/2019 | Serial | 007 Last Visit: 12/02/2019 |
| Patient Name | Mrs. SOMA DAS | Contact No | 260527028 |
| Address | 3/C CHATRA GHOSH PARA | Age | 34 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||