Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00355 | Date 11/08/2018 |
| Token No | SM/19-20/2792 15/05/2019 | Serial | 032 Last Visit: 15/05/2019 |
| Patient Name | Mrs. PIYALI DAS | Contact No | 9163109461 |
| Address | 17 PNK BANERJEE LANE CHATRA GARGARI GHAT SERAMPORE | Age | 27 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||