Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 03701 | Date 19/02/2019 |
| Token No | SM/18-19/9039 19/02/2019 | Serial | 069 Last Visit: 19/02/2019 |
| Patient Name | Miss AFRIN KHATUN | Contact No | 9088249604 |
| Address | 10 T C GOSWAMI STREET | Age | 11 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 24 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||