Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 06912 | Date 19/11/2019 |
| Token No | SM/19-20/13560 19/11/2019 | Serial | 057 Last Visit: 19/11/2019 |
| Patient Name | Mrs. SUCHISMITA DEY | Contact No | 9330221517 |
| Address | 9/B ROY M C LAHIRI BAHADUR STREET | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||