Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 05052 | Date 10/05/2019 |
| Token No | SM/19-20/2408 10/05/2019 | Serial | 005 Last Visit: 10/05/2019 |
| Patient Name | Mrs. DIPALI SOM | Contact No | 9913885672 |
| Address | 17B CHATRA DUTTA PARA LANE SERAMPORE | Age | 42 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 74 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||