Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 00123 | Date 04/08/2018 |
| Token No | SM/18-19/126 04/08/2018 | Serial | 022 Last Visit: 09/03/2019 |
| Patient Name | Miss TRISHA GHOSH | Contact No | 9051612177 |
| Address | 27 CHAKRABORTY LANE CHATRA | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 25 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||