Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04930 | Date 26/04/2019 |
| Token No | SM/19-20/1791 27/04/2019 | Serial | 040 Last Visit: 27/04/2019 |
| Patient Name | Mrs. MANGALA MONDAL | Contact No | |
| Address | 51C/4 BARO BAGAN SERAMPORE(M) | Age | 30 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||