Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05779 | Date 15/07/2019 |
| Token No | SM/19-20/6526 15/07/2019 | Serial | 069 Last Visit: 15/07/2019 |
| Patient Name | Mrs. MINA BIBI | Contact No | 7890277803 |
| Address | 15/A KANAI DEWAN TALA LANE SERAMPORE SHEORAPHULI | Age | 35 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 78 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||