Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 06584 | Date 30/09/2019 |
| Token No | SM/19-20/11357 30/09/2019 | Serial | 030 Last Visit: 30/09/2019 |
| Patient Name | Miss PIYASA POREL | Contact No | 9883823256 |
| Address | 118/N CHATRA,TELI PARA,BAIDYABATI(M) | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 47 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||