Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 05049 | Date 08/05/2019 |
| Token No | SM/19-20/8654 19/08/2019 | Serial | 108 Last Visit: 12/10/2020 |
| Patient Name | Mrs. DALI SOM | Contact No | 8902601090 |
| Address | 17 DUTTA LANE SERAMPORE | Age | 75 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 57 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||