Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 03382 | Date 05/02/2019 |
| Token No | SM/18-19/8048 05/02/2019 | Serial | 039 Last Visit: 05/02/2019 |
| Patient Name | Mrs. SARMILA DAS | Contact No | 9830309916 |
| Address | 18 RAJA K L GOSWAMI STREET | Age | 25 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 56 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||