Ticket for Outdoor Patient
| Ward No. 20 | U-PHC No. | Registration No. 09107 | Date 29/12/2020 |
| Token No | SM/21-22/2503 24/06/2021 | Serial | 004 Last Visit: 24/06/2021 |
| Patient Name | Miss MOUMITA SUR | Contact No | 8017505980 |
| Address | CHARABAGAN BAUREPARA, BAIDYABATI(M) | Age | 11 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||