Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01195 | Date 18/09/2018 |
| Token No | SM/18-19/4447 30/11/2018 | Serial | 036 Last Visit: 30/11/2018 |
| Patient Name | Mrs. RAJINA KHATUN | Contact No | |
| Address | 10/Z CHATRA GODAR BAGAN BYE LANE, BAIDYABATI (M) | Age | 18 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 42 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||