Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 06211 | Date 24/08/2019 |
| Token No | SM/19-20/9035 24/08/2019 | Serial | 012 Last Visit: 24/08/2019 |
| Patient Name | Mrs. MALATI BAG | Contact No | 7687942090 |
| Address | HARIPUR BAZAR BARIDIARA PAHALAMPUR , PAHALAMPUR, DIARA | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 52 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||