Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00741 | Date 27/08/2018 |
| Token No | SM/18-19/8327 08/02/2019 | Serial | 053 Last Visit: 12/03/2019 |
| Patient Name | Mrs. KALPANA SOM | Contact No | 9433652852 |
| Address | 67 C MARADAN GT ROAD SERAMPORE | Age | 52.0 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||