Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 06744 | Date 23/10/2019 |
| Token No | SM/19-20/12285 23/10/2019 | Serial | 023 Last Visit: 23/10/2019 |
| Patient Name | Miss ANKITA DOLUI | Contact No | 9038944668 |
| Address | CHATRA BAGER BAGAN TELI PARA | Age | 9 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 25 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||