Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03214 | Date 29/01/2019 |
| Token No | SM/18-19/7534 29/01/2019 | Serial | 027 Last Visit: 17/01/2020 |
| Patient Name | Miss SRIJANI DAS | Contact No | 8902479437 |
| Address | 3/B CHATRA GHOSH PARA 2ND LANE SERAMPORE | Age | 14 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||