Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02687 | Date 27/12/2018 |
| Token No | SM/18-19/5769 27/12/2018 | Serial | 027 Last Visit: 27/12/2018 |
| Patient Name | Miss PIYA DAS | Contact No | |
| Address | 17 P.N.K BANERJEE LANE | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 16 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||