Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05639 | Date 02/07/2019 |
| Token No | SM/19-20/17788 08/02/2020 | Serial | 009 Last Visit: 08/02/2020 |
| Patient Name | Mrs. CHYANA MODAK | Contact No | 9674512180 |
| Address | CHATRA TETUL TALA,G. T. ROAD,BAIDYABATI(M) | Age | 36 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 63 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||