Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01196 | Date 18/09/2018 |
| Token No | SM/18-19/5693 24/12/2018 | Serial | 016 Last Visit: 15/01/2019 |
| Patient Name | Baby TINA KHAN | Contact No | 900763926 |
| Address | 156/73 G.T ROAD , BAIDYABATI (M) | Age | 4 YRS 6 MNTH Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 12 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||