Ticket for Outdoor Patient
| Ward No. 21 | U-PHC No. | Registration No. 09074 | Date 18/12/2020 |
| Token No | SM/20-21/28580 18/12/2020 | Serial | 028 Last Visit: 18/12/2020 |
| Patient Name | Mrs. SUKLA SHIKDAR | Contact No | 9674138289 |
| Address | 32/55/1/1 N S ROAD SHEORAPHULI BAIDYABATI (M) | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||