Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 04725 | Date 16/04/2019 |
| Token No | SM/19-20/984 16/04/2019 | Serial | 100 Last Visit: 16/04/2019 |
| Patient Name | Mrs. ALPANA GHOSH | Contact No | |
| Address | 14 CHATRA CHAPA TALA LANE SERAMPORE | Age | 60 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||