Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01943 | Date 14/11/2018 |
| Token No | SM/18-19/3613 14/11/2018 | Serial | 002 Last Visit: 20/11/2018 |
| Patient Name | Mr. BIBEK MAJHI | Contact No | 8420282175 |
| Address | 16/A G T ROAD CHATRA GODAR BAGAN BY LANE | Age | 13 YRS Male |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 36 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||