Ticket for Outdoor Patient
| Ward No. 20 | U-PHC No. | Registration No. 03864 | Date 25/02/2019 |
| Token No | SM/18-19/9445 25/02/2019 | Serial | 052 Last Visit: 21/09/2019 |
| Patient Name | Miss MOUSUMI MODAK | Contact No | 7044695770 |
| Address | RAMKRISHNA ROAD,BAIDYABATI(M) | Age | 15 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||