Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 07256 | Date 30/12/2019 |
| Token No | SM/19-20/19389 11/03/2020 | Serial | 052 Last Visit: 11/03/2020 |
| Patient Name | Mrs. SUMANTIKA GHORUI | Contact No | 7449403695 |
| Address | TELIPARA BAGER BAGAN CHATRA | Age | 20 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 43 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||