Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 03497 | Date 12/02/2019 |
| Token No | SM/18-19/10953 20/03/2019 | Serial | 058 Last Visit: 22/06/2019 |
| Patient Name | Baby KALYANI RAM | Contact No | 8274900535 |
| Address | CHATRA TETULTALA BAIDYABATI(M) | Age | 2.3 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 11 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||