Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02177 | Date 28/11/2018 |
| Token No | SM/18-19/4293 28/11/2018 | Serial | 025 Last Visit: 28/11/2018 |
| Patient Name | Baby AYUSHI SOMANI | Contact No | 8910832877 |
| Address | 10/Z/A/A CHATRA GOADAR BAGAN BYE LANE BAIDYABATI (M) | Age | 5 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 17 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||