Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 05123 | Date 15/05/2019 |
| Token No | SM/19-20/2814 15/05/2019 | Serial | 054 Last Visit: 15/05/2019 |
| Patient Name | Mrs. URMILA PAL | Contact No | 8334947615 |
| Address | 22/2 KALITALA LANE CHATRA , BAIDYABATI(M) | Age | 42 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 41 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||