Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01050 | Date 11/09/2018 |
| Token No | SM/18-19/1517 11/09/2018 | Serial | 047 Last Visit: 11/09/2018 |
| Patient Name | Master SACHI SOMANI | Contact No | 8910832877 |
| Address | 10/Z/A/A CHATRA GOADAR BAGAN BYE LANE BAIDYABATI (M) | Age | 3.0 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 12 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||