Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03875 | Date 26/02/2019 |
| Token No | SM/19-20/5729 02/07/2019 | Serial | 019 Last Visit: 24/07/2025 |
| Patient Name | Mrs. MOUMITA MODAK | Contact No | 9674512180 |
| Address | 61/B G T ROAD CHATRA TETUL TALA BAIDYABATI(M) | Age | 10 Years,11 Months,20 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 27 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||