Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03767 | Date 21/02/2019 |
| Token No | SM/18-19/10384 11/03/2019 | Serial | 093 Last Visit: 11/03/2019 |
| Patient Name | Miss LIPIKA MAJHI | Contact No | 9339297570 |
| Address | 23/A CHATRA GODAR BAGAN BY LANE , BAIDYABATI(M) | Age | 16 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||