Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05282 | Date 29/05/2019 |
| Token No | SM/19-20/3656 29/05/2019 | Serial | 023 Last Visit: 29/05/2019 |
| Patient Name | Miss CHAITALI MAJHI | Contact No | 7595883309 |
| Address | 57/A/J/O GODAR BAGAN BYE LANE, BAIDYABATI(M) | Age | 19 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 44 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||