Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 09101 | Date 28/12/2020 |
| Token No | SM/21-22/9751 10/02/2022 | Serial | 012 Last Visit: 27/08/2025 |
| Patient Name | Mrs. BULA DAS | Contact No | 9163002893 |
| Address | 33 BARABAGAN LANE SERAMPORE | Age | 58 Years,7 Months,25 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||