Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 02725 | Date 28/12/2018 |
| Token No | SM/18-19/5940 28/12/2018 | Serial | 082 Last Visit: 05/04/2019 |
| Patient Name | Baby SOUROMI BERA | Contact No | 9748353681 |
| Address | 19 RAM KRISHNA ROAD CHATRA MANNA PARA , BAIDYABATI (M) | Age | 3 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 14 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||