Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03258 | Date 31/01/2019 |
| Token No | SM/18-19/7685 31/01/2019 | Serial | 059 Last Visit: 04/02/2019 |
| Patient Name | Mrs. SONALI DAS | Contact No | 9073757963 |
| Address | CHATRA BAGER BAGAN , BAIDYABATI (M) | Age | 21 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 49 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||