Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05246 | Date 27/05/2019 |
| Token No | SM/19-20/3496 27/05/2019 | Serial | 052 Last Visit: 30/05/2019 |
| Patient Name | Mrs. RINA CHAKRABORTY | Contact No | |
| Address | 50 CHAKRABORTY LANE SERAMPORE | Age | 42 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 95 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||