Ticket for Outdoor Patient
| Ward No. 20 | U-PHC No. | Registration No. 03709 | Date 19/02/2019 |
| Token No | SM/18-19/9062 19/02/2019 | Serial | 092 Last Visit: 19/02/2019 |
| Patient Name | Miss ISHITA SHAW | Contact No | 9748046181 |
| Address | SHEWRAPHULI CHARA BAGAN | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 18 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||