Ticket for Outdoor Patient
| Ward No. 7 | U-PHC No. | Registration No. 05301 | Date 30/05/2019 |
| Token No | SM/19-20/3757 31/05/2019 | Serial | 001 Last Visit: 01/06/2019 |
| Patient Name | Mrs. CHANDRABATI DOLUI | Contact No | 7003008618 |
| Address | 13 N.N RAY STREET SERAMPORE | Age | 65 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 57 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||