Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 05214 | Date 23/05/2019 |
| Token No | SM/19-20/3314 23/05/2019 | Serial | 062 Last Visit: 06/08/2019 |
| Patient Name | Mrs. SALMA BEGAM | Contact No | 8478988101 |
| Address | 89C MALLICK PARA | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||