Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02084 | Date 22/11/2018 |
| Token No | SM/18-19/4034 22/11/2018 | Serial | 029 Last Visit: 22/11/2018 |
| Patient Name | Miss RINKI CHAKRABORTY | Contact No | 9874939204 |
| Address | 14/A LAHIRI PARA LANE | Age | 13 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 35 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||