Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05196 | Date 22/05/2019 |
| Token No | SM/19-20/4712 17/06/2019 | Serial | 029 Last Visit: 17/06/2019 |
| Patient Name | Mrs. RITA SHAW | Contact No | 8334844620 |
| Address | 281/B/A/1, GHOSAL PARA NABAGRAM, BAIDYABATI(M) | Age | 37 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 58 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||