Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 03526 | Date 12/02/2019 |
| Token No | SM/25-26/4035 23/07/2025 | Serial | 065 Last Visit: 23/07/2025 |
| Patient Name | Miss MANISHA MODAK | Contact No | 9674512180 |
| Address | 61/B G T ROAD CHATRA TENTULTALA BAIDYABATI (M) | Age | 8 Years,6 Months,20 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 46.1 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||