Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 04995 | Date 02/05/2019 |
| Token No | SM/19-20/2073 02/05/2019 | Serial | 044 Last Visit: 02/05/2019 |
| Patient Name | Mrs. MANOWARA BEGAM | Contact No | 8296499552 |
| Address | 26/A MIAJANDARJEE LANE CHOTTO MASJID SERAMPORE | Age | 42 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 83.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||