Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04400 | Date 26/03/2019 |
| Token No | SM/18-19/11252 26/03/2019 | Serial | 045 Last Visit: 26/03/2019 |
| Patient Name | Miss SUPRIYA BURNWAL | Contact No | 8981490952 |
| Address | CHATRA TELI PARA BAGER BAGAN , BAIDYABATI(M) | Age | 10 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||