Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 05612 | Date 28/06/2019 |
| Token No | SM/19-20/7969 05/08/2019 | Serial | 108 Last Visit: 05/08/2019 |
| Patient Name | Miss CHUMKI DAS | Contact No | 6289579557 |
| Address | 13 A RAJA K.L GOSWAMI STREET SERAMPORE | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 74 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||