Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 04920 | Date 26/04/2019 |
| Token No | SM/19-20/2253 07/05/2019 | Serial | 034 Last Visit: 14/05/2019 |
| Patient Name | Mrs. MOU SAMANTA | Contact No | 7595842595 |
| Address | 36/C A.P GHOSH ROAD SERAMPORE | Age | 30 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 70 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||