Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 03500 | Date 12/02/2019 |
| Token No | SM/18-19/8436 12/02/2019 | Serial | 040 Last Visit: 12/02/2019 |
| Patient Name | Baby HIYA LAHA | Contact No | |
| Address | 101/A CHATRA BARUI PARA LANE | Age | 5 MONTH Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||