Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 04144 | Date 11/03/2019 |
| Token No | SM/18-19/10319 11/03/2019 | Serial | 028 Last Visit: 11/03/2019 |
| Patient Name | Miss UPASONA PATRA | Contact No | 9331557379 |
| Address | 21 CHATRA BAJAR ROAD SERAMPORE | Age | 6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 19 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||