Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 06948 | Date 21/11/2019 |
| Token No | SM/19-20/13740 21/11/2019 | Serial | 078 Last Visit: 21/11/2019 |
| Patient Name | Mrs. MOUSUMI DOLUI | Contact No | 9330423326 |
| Address | 30/A NO KANAI DEWAN TALA , SERAMPORE(M) | Age | 26 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 44 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||