Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04182 | Date 12/03/2019 |
| Token No | SM/18-19/10429 12/03/2019 | Serial | 020 Last Visit: 12/03/2019 |
| Patient Name | Miss MRINALINI GUIN | Contact No | 9836695045 |
| Address | CHATRA TETUL TALA,BAIDYABATY(M) | Age | 15 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 33 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||