Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03688 | Date 19/02/2019 |
| Token No | SM/18-19/8978 19/02/2019 | Serial | 008 Last Visit: 19/02/2019 |
| Patient Name | Mrs. MOUMITA DOLUI | Contact No | 9477515272 |
| Address | SHEWRAPHULI KANAHAI DAN TALA , BAIDYABATI (M) | Age | 21 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||