Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03173 | Date 25/01/2019 |
| Token No | SM/18-19/7413 25/01/2019 | Serial | 003 Last Visit: 25/01/2019 |
| Patient Name | Miss ANAMIKA GOSWAMI | Contact No | |
| Address | 55 BOROBAGAN LANE | Age | 10.6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||