Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 05080 | Date 13/05/2019 |
| Token No | SM/19-20/2595 13/05/2019 | Serial | 006 Last Visit: 13/05/2019 |
| Patient Name | Mrs. MOSLEMA BEGAM | Contact No | 9163488997 |
| Address | 3/A CHILEKHANA ROAD SERAMPORE MALLIKPARA | Age | 48 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | 130/80 mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||