Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04452 | Date 28/03/2019 |
| Token No | SM/18-19/11484 28/03/2019 | Serial | 086 Last Visit: 28/03/2019 |
| Patient Name | Miss RIYA BURMAN | Contact No | 8276070518 |
| Address | CHATRA BAGER BAGAN, BAIDYABATI(M) | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 19 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||