Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03159 | Date 24/01/2019 |
| Token No | SM/19-20/22590 30/05/2020 | Serial | 006 Last Visit: 25/08/2020 |
| Patient Name | Mrs. MOUSUMI SANYAL | Contact No | 9831632998 |
| Address | 47/G/1 RAJA RAM MOHAN ROY SARANI SERAMPORE | Age | 45 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||