Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 10409 | Date 13/12/2021 |
| Token No | SM/21-22/7708 13/12/2021 | Serial | 005 Last Visit: 13/12/2021 |
| Patient Name | Mrs. MOUMITA SINHA | Contact No | |
| Address | 42/D BORO BAGAN LANE | Age | 36 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||