Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 03750 | Date 21/02/2019 |
| Token No | SM/18-19/9156 21/02/2019 | Serial | 018 Last Visit: 21/02/2019 |
| Patient Name | Mrs. MAYA SHAW | Contact No | 8961659546 |
| Address | 100 CHATRA MANNA PARA RAMKRISHNA ROAD, BAIDYABATI(M) | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 59 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||