Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 05162 | Date 20/05/2019 |
| Token No | SM/19-20/3024 20/05/2019 | Serial | 072 Last Visit: 20/05/2019 |
| Patient Name | Mrs. REKHA PAL | Contact No | 9339714030 |
| Address | 178 SHITLATALA ROAD , BAIDYABATI(M) | Age | 56 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||