Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01713 | Date 27/10/2018 |
| Token No | SM/18-19/3004 27/10/2018 | Serial | 053 Last Visit: 12/11/2018 |
| Patient Name | Miss AINDRILA PAUL | Contact No | 6291591979 |
| Address | 269 D/ A NABOGRAM GHOSAL PARA | Age | 11 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||