Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 05697 | Date 08/07/2019 |
| Token No | SM/19-20/6055 08/07/2019 | Serial | 028 Last Visit: 08/07/2019 |
| Patient Name | Mrs. JYOTSNA KHATUN | Contact No | 8335958343 |
| Address | 23/A MIYAJEN DARJI LANE MALLICK PARA | Age | 20 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||