Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 00572 | Date 20/08/2018 |
| Token No | SM/19-20/11812 16/10/2019 | Serial | 030 Last Visit: 02/12/2019 |
| Patient Name | Mrs. MAYA DAS | Contact No | 8017353769 |
| Address | 24/8/2 TELIPARA BAIDYABATI(M) | Age | 60 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 51 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||