Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02165 | Date 27/11/2018 |
| Token No | SM/18-19/4262 27/11/2018 | Serial | 054 Last Visit: 01/12/2018 |
| Patient Name | Miss ADITI KARMAKAR | Contact No | |
| Address | 409/268 G T ROAD,CHATRA BOU BAZAR | Age | 13 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||