Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 04866 | Date 23/04/2019 |
| Token No | SM/19-20/1495 23/04/2019 | Serial | 076 Last Visit: 23/04/2019 |
| Patient Name | Mrs. SHAMPA HAPAR | Contact No | 8582880281 |
| Address | CHATRA BAGER BAGAN TELI PARA , BAIDYABATI(M) | Age | 24 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||