Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 06395 | Date 13/09/2019 |
| Token No | SM/19-20/10381 14/09/2019 | Serial | 060 Last Visit: 16/09/2019 |
| Patient Name | Mrs. KALPANA SAMANTA | Contact No | 9007561524 |
| Address | 4/1(8) SATCHASI PARA CHATRA , BAIDYABATI(M) | Age | 57 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||