Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05204 | Date 23/05/2019 |
| Token No | SM/19-20/3256 23/05/2019 | Serial | 004 Last Visit: 23/05/2019 |
| Patient Name | Mrs. KANCHAN MAJHI | Contact No | 8582907465 |
| Address | 24 TELI PARA BAGER BAGAN , BAIDYABATI(M) | Age | 38 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | 120/80 mmHg | Weight | 58 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||