Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02217 | Date 29/11/2018 |
| Token No | SM/18-19/4392 29/11/2018 | Serial | 053 Last Visit: 29/11/2018 |
| Patient Name | Miss MOUSUMI HALDER | Contact No | 7890526942 |
| Address | CHATRA BAGHER BAGAN | Age | 11 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 28 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||