Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03756 | Date 21/02/2019 |
| Token No | SM/18-19/9591 28/02/2019 | Serial | 013 Last Visit: 28/02/2019 |
| Patient Name | Mrs. GOURI DAS | Contact No | 9748029339 |
| Address | CHATRA LANKAR BAGAN , BAIDYABATI(M) | Age | 60 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||