Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01643 | Date 12/10/2018 |
| Token No | SM/18-19/2805 12/10/2018 | Serial | 012 Last Visit: 12/10/2018 |
| Patient Name | Miss BRISTI PAL | Contact No | 8582877763 |
| Address | 13 B CHATRA KUMARPARA | Age | 11 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 39 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||