Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 00776 | Date 28/08/2018 |
| Token No | SM/18-19/1382 08/09/2018 | Serial | 011 Last Visit: 27/08/2022 |
| Patient Name | Mr. OM DAS | Contact No | 7890210986 |
| Address | GODAR BAGAN BAIDYABATI(M) | Age | 12 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 21 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||