Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 09360 | Date 19/03/2021 |
| Token No | SM/20-21/30942 19/03/2021 | Serial | 051 Last Visit: 19/03/2021 |
| Patient Name | Mrs. VIMCHANDRA MONDAL | Contact No | 8334880073 |
| Address | 78N/129, TELIPARA, BAGER BAGAN, BAIDYABATI(M),712204 | Age | 63 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||