Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02452 | Date 10/12/2018 |
| Token No | SM/18-19/5007 10/12/2018 | Serial | 055 Last Visit: 10/12/2018 |
| Patient Name | Mr. SUBHO MONDAL | Contact No | 8013332298 |
| Address | CHATRA TELI PARA,BAIDAYBATY (M) | Age | 14 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 41 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||