Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01687 | Date 26/10/2018 |
| Token No | SM/18-19/2927 26/10/2018 | Serial | 041 Last Visit: 26/10/2018 |
| Patient Name | Miss TUMPA PAL | Contact No | 9051195514 |
| Address | 7 C BAHIR SERAMPORE.BAIDAYBATI(M) | Age | 12 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 29 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||