Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 01587 | Date 09/10/2018 |
| Token No | SM/18-19/8657 14/02/2019 | Serial | 022 Last Visit: 14/02/2019 |
| Patient Name | Miss NAMITA KHAN | Contact No | |
| Address | 100/73A CHATRA BAGER BAGAN , BAIDYABATI (M) | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 20 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||