Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00419 | Date 14/08/2018 |
| Token No | SM/19-20/3258 23/05/2019 | Serial | 006 Last Visit: 19/06/2020 |
| Patient Name | Mrs. SHAMPA ROY | Contact No | 7278056813 |
| Address | 21, GHOSH PARA 1ST LANE | Age | 39 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 59 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||