Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02526 | Date 14/12/2018 |
| Token No | SM/19-20/9151 26/08/2019 | Serial | 067 Last Visit: 17/12/2025 |
| Patient Name | Mrs. MIRA DEY | Contact No | 9051957062 |
| Address | 18 CHATRA CHAPA TALA LANE | Age | 70 Years,11 Months,15 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||