Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03698 | Date 19/02/2019 |
| Token No | SM/18-19/9027 19/02/2019 | Serial | 057 Last Visit: 15/07/2019 |
| Patient Name | Mrs. RUPALI MONDOL | Contact No | 7890399392 |
| Address | CHATRA,BAGHER BAGAN,TELI PARA,BAIDYABATI(M) | Age | 23 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 42 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||