Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 06700 | Date 21/10/2019 |
| Token No | SM/19-20/12105 21/10/2019 | Serial | 002 Last Visit: 21/10/2019 |
| Patient Name | Mrs. MAHUA GOSWAMI | Contact No | 6290526575 |
| Address | 167 (73/B) BAGER BAGAN , TELI PARA , BAIDYABATI(M) | Age | 39 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 51 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||