Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01167 | Date 15/09/2018 |
| Token No | SM/18-19/1711 15/09/2018 | Serial | 031 Last Visit: 12/09/2019 |
| Patient Name | Mrs. CHUMKI MONDAL | Contact No | 9836855371 |
| Address | 164 CHATRA BAGER BAGAN, BAIDYABATI (M) | Age | 12 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||