Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04156 | Date 11/03/2019 |
| Token No | SM/18-19/10350 11/03/2019 | Serial | 059 Last Visit: 11/03/2019 |
| Patient Name | Miss NEHA KHATUN | Contact No | 8444979212 |
| Address | CHATRA ARABINDA SARANI | Age | 12 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||