Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05686 | Date 06/07/2019 |
| Token No | SM/21-22/4905 09/09/2021 | Serial | 003 Last Visit: 09/09/2021 |
| Patient Name | Miss TRISA DAS | Contact No | 9674416198 |
| Address | 73/3 CHATRA G.T ROAD JAL TANK , BAIDYABATI(M) | Age | 20 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||