Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 00623 | Date 21/08/2018 |
| Token No | SM/18-19/745 21/08/2018 | Serial | 043 Last Visit: 21/08/2018 |
| Patient Name | Mrs. MOUSUMI MALLIK | Contact No | 9902870929 |
| Address | CHATRA BAGER BAGAN | Age | 13.0 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 27 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||