Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04480 | Date 30/03/2019 |
| Token No | SM/18-19/11631 30/03/2019 | Serial | 046 Last Visit: 30/03/2019 |
| Patient Name | Miss GULABSA KHATUN | Contact No | 7044291403 |
| Address | CHATRA MUSALMAN PARA SERAMPORE | Age | 16 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 42 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||