Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05962 | Date 26/07/2019 |
| Token No | SM/19-20/10592 18/09/2019 | Serial | 013 Last Visit: 04/10/2019 |
| Patient Name | Mrs. SHELLEY ADAK | Contact No | 9475100476 |
| Address | SERAMPORE AMULAKANANA | Age | 44 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||