Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04729 | Date 17/04/2019 |
| Token No | SM/19-20/1013 17/04/2019 | Serial | 020 Last Visit: 17/04/2019 |
| Patient Name | Mrs. CHABI HALDAR | Contact No | |
| Address | 171 TELI PARA BAIDYABATI(M) | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 53 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||