Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03075 | Date 18/01/2019 |
| Token No | SM/21-22/6581 03/11/2021 | Serial | 030 Last Visit: 27/11/2025 |
| Patient Name | Mrs. MIRA DAS | Contact No | 9432200596 |
| Address | 3C CHATRA GHOSH PARA | Age | 68 Years,10 Months,25 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||