Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 06039 | Date 02/08/2019 |
| Token No | SM/19-20/7836 02/08/2019 | Serial | 068 Last Visit: 02/08/2019 |
| Patient Name | Mrs. CHAMPA DAS | Contact No | 9163517709 |
| Address | 25A CHATRA DHARMOTALA LANE SERAMPORE | Age | 40 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 54 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||