Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02660 | Date 22/12/2018 |
| Token No | SM/18-19/5674 22/12/2018 | Serial | 051 Last Visit: 22/12/2018 |
| Patient Name | Miss MOUPARNA PAL | Contact No | 9007666856 |
| Address | 14 CHATRA BARUI PARA LANE | Age | 9 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 33 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||