Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05873 | Date 20/07/2019 |
| Token No | SM/21-22/2414 22/06/2021 | Serial | 003 Last Visit: 22/06/2021 |
| Patient Name | Mrs. BELA CHAKRABORTY | Contact No | 8274948084 |
| Address | 21/A/C G.T ROAD CHATRA,GODER BAGAN,BAIDYABATI(M) | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||