Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03559 | Date 13/02/2019 |
| Token No | SM/19-20/6372 13/07/2019 | Serial | 036 Last Visit: 13/07/2019 |
| Patient Name | Miss CHUMKI MANDOL | Contact No | 9836855371 |
| Address | 164 CHATRA TELIPARA, | Age | 11 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||