Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03148 | Date 22/01/2019 |
| Token No | SM/19-20/6727 18/07/2019 | Serial | 002 Last Visit: 18/01/2023 |
| Patient Name | Mrs. CHAYARANI MODOK | Contact No | 9674512180 |
| Address | 61/B GT ROAD CHATRA TETUL TALA,BAIDYABATI(M) | Age | 72 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 46 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||