Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 07134 | Date 12/12/2019 |
| Token No | SM/19-20/15125 12/12/2019 | Serial | 045 Last Visit: 12/12/2019 |
| Patient Name | Mrs. DOLI DAS | Contact No | 9874855376 |
| Address | TARAKESWAR ROAD UTTAR RAJYADHARPUR CHAPSARA, BAIDYABATI | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||