Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 02763 | Date 31/12/2018 |
| Token No | SM/18-19/6060 31/12/2018 | Serial | 059 Last Visit: 31/12/2018 |
| Patient Name | Mr. SUMIT BAIRAGI | Contact No | 8478898969 |
| Address | CHATRA BAGHER BAGAN,TELIPARA,BAIDYABATI(M) | Age | 10 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 20 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||