Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01847 | Date 02/11/2018 |
| Token No | SM/18-19/3320 02/11/2018 | Serial | 004 Last Visit: 02/11/2018 |
| Patient Name | Mr. SK HASIM | Contact No | 6291009107 |
| Address | 32 CHATRA MUSALMANPARA | Age | 15 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||