Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 04309 | Date 20/03/2019 |
| Token No | SM/18-19/10904 20/03/2019 | Serial | 009 Last Visit: 20/03/2019 |
| Patient Name | Miss SIBHASREE SOM | Contact No | 6291086784 |
| Address | 24A CHATRA BARUI PARA LANE | Age | 17 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||