Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03941 | Date 01/03/2019 |
| Token No | SM/18-19/9680 01/03/2019 | Serial | 055 Last Visit: 01/03/2019 |
| Patient Name | Miss USMITA SOM | Contact No | 9088135102 |
| Address | 19B CHATRA SHIB TALA | Age | 12 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||