Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02000 | Date 16/11/2018 |
| Token No | SM/18-19/3791 16/11/2018 | Serial | 024 Last Visit: 16/11/2018 |
| Patient Name | Miss SUSMITA BARIK | Contact No | 8100078013 |
| Address | CHATRA SHITLATALA KUMOR BAGAN , BAIDYABATI (M) | Age | 16 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||