Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 02166 | Date 27/11/2018 |
| Token No | SM/18-19/8554 13/02/2019 | Serial | 021 Last Visit: 13/02/2019 |
| Patient Name | Miss MADHUMITA HALDER | Contact No | |
| Address | 133 CHATRA BARUI PARA | Age | 14 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 33 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||