Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02753 | Date 31/12/2018 |
| Token No | SM/18-19/7326 24/01/2019 | Serial | 013 Last Visit: 16/09/2019 |
| Patient Name | Miss SUMITA DAS | Contact No | 8420165898 |
| Address | 66, CHATRA DHARMOTALA LANE | Age | 10 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 30 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||