Ticket for Outdoor Patient
| Ward No. 24 | U-PHC No. | Registration No. 03029 | Date 16/01/2019 |
| Token No | SM/19-20/5427 27/06/2019 | Serial | 010 Last Visit: 27/06/2019 |
| Patient Name | Mrs. MOUSUMI SHASMAL | Contact No | 9836846441 |
| Address | 24 SHIVTALA LANE MAHESH SERAMPORE | Age | 32 yrs Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 69 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||