Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05197 | Date 22/05/2019 |
| Token No | SM/19-20/3216 22/05/2019 | Serial | 057 Last Visit: 22/05/2019 |
| Patient Name | Mrs. SUSMITA GHOSH | Contact No | 7001727299 |
| Address | 27/2 CHATRA KUMAR PARA SERAMPORE | Age | 29 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 47 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||