Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03977 | Date 02/03/2019 |
| Token No | SM/18-19/9778 02/03/2019 | Serial | 097 Last Visit: 02/03/2019 |
| Patient Name | Miss PIYALI DAS | Contact No | 8274840637 |
| Address | CHATRA BAGER BAGAN TELIPARA | Age | 12 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 29 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||