Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 03239 | Date 30/01/2019 |
| Token No | SM/18-19/8885 18/02/2019 | Serial | 058 Last Visit: 06/04/2019 |
| Patient Name | Mrs. BASIRUN BIBI | Contact No | |
| Address | MALLICK PARA,SERAMPORE | Age | 75 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||