Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 00644 | Date 23/08/2018 |
| Token No | SM/18-19/775 23/08/2018 | Serial | 024 Last Visit: 10/02/2020 |
| Patient Name | Mrs. SIBANI DAS | Contact No | 9330534335 |
| Address | 18, RAJA K.L GOSWAMI STREET | Age | 8.0 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 21 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||