Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03186 | Date 25/01/2019 |
| Token No | SM/18-19/7468 25/01/2019 | Serial | 058 Last Visit: 25/01/2019 |
| Patient Name | Miss SOMA DAS | Contact No | 9073202252 |
| Address | CHATRA BAGHER BAGAN,BAIDYABATI(M) | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 13 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||