Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 04046 | Date 06/03/2019 |
| Token No | SM/18-19/9989 06/03/2019 | Serial | 079 Last Visit: 06/03/2019 |
| Patient Name | Miss ESHA GANGULY | Contact No | 9674153428 |
| Address | CHATRA SITALA TALA SACASIPARA | Age | 13 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | 43 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||