Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05637 | Date 02/07/2019 |
| Token No | SM/19-20/5728 02/07/2019 | Serial | 018 Last Visit: 08/02/2020 |
| Patient Name | Baby MONISA MODOK | Contact No | 9674512180 |
| Address | CHATRA TETUL TALA BAZER,G. T. ROAD,BAIDYABATI(M) | Age | 2 Y 2 M Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 8 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||