Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00707 | Date 25/08/2018 |
| Token No | SM/18-19/866 25/08/2018 | Serial | 035 Last Visit: 25/08/2018 |
| Patient Name | Baby SAMPA SIL | Contact No | |
| Address | SHEORAPHULY | Age | 6.0 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 18 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||