Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 03601 | Date 15/02/2019 |
| Token No | SM/18-19/8761 15/02/2019 | Serial | 049 Last Visit: 15/02/2019 |
| Patient Name | Miss AFSANA KHATUN | Contact No | 9051867258 |
| Address | 83 MALLICK PARA,SERAMPORE | Age | 17 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 37 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||