Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 02714 | Date 28/12/2018 |
| Token No | SM/21-22/2762 02/07/2021 | Serial | 035 Last Visit: 02/07/2021 |
| Patient Name | Mrs. ROSHONARA BEGAM | Contact No | 7449644348 |
| Address | MALLICK PARA MIYA DARJI LANE | Age | 40 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||