Ticket for Outdoor Patient
| Ward No. 20 | U-PHC No. | Registration No. 04694 | Date 13/04/2019 |
| Token No | SM/19-20/2141 04/05/2019 | Serial | 001 Last Visit: 24/08/2019 |
| Patient Name | Mrs. SONA RAY | Contact No | 7688016516 |
| Address | CHARA BAGAN BAURI PARA, BAIDYABATI(M) | Age | 60 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||