Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 01989 | Date 15/11/2018 |
| Token No | SM/18-19/3753 15/11/2018 | Serial | 048 Last Visit: 15/11/2018 |
| Patient Name | Miss MARIAM MALLICK | Contact No | 9051146605 |
| Address | KHANDAKAR PARA(SHEOPHULI) | Age | 15 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45.5 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||