Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 07143 | Date 13/12/2019 |
| Token No | SM/19-20/15223 13/12/2019 | Serial | 059 Last Visit: 13/12/2019 |
| Patient Name | Miss BANANI SIMLAI | Contact No | 6290651790 |
| Address | 35/A SASHIBHUSAN GHOSH LANE SERAMPORE | Age | 26 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 52 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||