Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03400 | Date 06/02/2019 |
| Token No | SM/19-20/9243 27/08/2019 | Serial | 051 Last Visit: 03/09/2019 |
| Patient Name | Mrs. BALIKA GHOSH | Contact No | 9748995057 |
| Address | VILL BARUNAN PARA POLBA , TRIBENI | Age | 70 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 42 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||