Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02162 | Date 27/11/2018 |
| Token No | SM/18-19/4259 27/11/2018 | Serial | 051 Last Visit: 06/03/2019 |
| Patient Name | Miss BARSHA KHATUN | Contact No | |
| Address | 20 CHATRA KUMAR PARA | Age | 4.6 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 34 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||