Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 04525 | Date 03/04/2019 |
| Token No | SM/19-20/154 03/04/2019 | Serial | 009 Last Visit: 03/04/2019 |
| Patient Name | Mrs. FIROJA KHAN | Contact No | |
| Address | 29B MIA JAN DARJI LANE MALIK PARA SERAMPORE (M) | Age | 48 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 57 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||