Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03088 | Date 19/01/2019 |
| Token No | SM/19-20/6609 16/07/2019 | Serial | 057 Last Visit: 16/07/2019 |
| Patient Name | Mrs. MOUSUMI DAS | Contact No | 7980012621 |
| Address | 50A CHATRA DHARMOTLA | Age | 32 yrs Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 69 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||