Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03743 | Date 21/02/2019 |
| Token No | SM/18-19/9480 26/02/2019 | Serial | 033 Last Visit: 03/07/2019 |
| Patient Name | Mrs. MOUMITA SRIMANI | Contact No | 9903757687 |
| Address | 2/B/2 A K C BHATTACHARYA STREET | Age | 24 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 51 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||