Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03366 | Date 04/02/2019 |
| Token No | SM/18-19/8005 04/02/2019 | Serial | 101 Last Visit: 04/02/2019 |
| Patient Name | Mrs. JHILIK DAS | Contact No | 9073202252 |
| Address | CHATRA,BAGHER BAGAN,TELI PARA,BAIDYABATI(M) | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||