Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02600 | Date 20/12/2018 |
| Token No | SM/18-19/5500 20/12/2018 | Serial | 013 Last Visit: 20/12/2018 |
| Patient Name | Miss TRISHNA CHAKRABORTY | Contact No | 9831870021 |
| Address | 2, CHATRA CHAPA TALA LANE | Age | 12 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 46 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||