Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05929 | Date 24/07/2019 |
| Token No | SM/19-20/7208 24/07/2019 | Serial | 050 Last Visit: 29/07/2019 |
| Patient Name | Mrs. JHILIK DAS (BANIK) | Contact No | 9062932050 |
| Address | CHATRA BAGER BAGAN TELI PARA , BAIDYABATI(M) | Age | 18 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||