Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03042 | Date 17/01/2019 |
| Token No | SM/18-19/6949 17/01/2019 | Serial | 029 Last Visit: 17/01/2019 |
| Patient Name | Mrs. SHARMISHA DAS | Contact No | 9088160136 |
| Address | 301/T/E CHATRA BAGER BAGAN TELI PARA , BAIDYABATI(M) | Age | 15 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||