Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05158 | Date 20/05/2019 |
| Token No | SM/19-20/5894 05/07/2019 | Serial | 057 Last Visit: 05/07/2019 |
| Patient Name | Mrs. MUKTA DHARA | Contact No | 9836714311 |
| Address | TELI PARA CHATRA , BAIDYABATI (M) | Age | 50 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||