Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 04382 | Date 25/03/2019 |
| Token No | SM/18-19/11190 25/03/2019 | Serial | 110 Last Visit: 25/03/2019 |
| Patient Name | Miss PIYA DAS | Contact No | 9674481194 |
| Address | 11, A P.N MUKHERJEE STREET | Age | 16 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 44 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||