Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 09055 | Date 16/12/2020 |
| Token No | SM/20-21/28470 16/12/2020 | Serial | 003 Last Visit: 16/12/2020 |
| Patient Name | Mrs. GITA JHA | Contact No | 9903992642 |
| Address | 71 G T ROAD, BAIDYABATI(M) | Age | 43 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||