Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 03779 | Date 22/02/2019 |
| Token No | SM/18-19/9233 22/02/2019 | Serial | 010 Last Visit: 22/02/2019 |
| Patient Name | Baby SANSKRITI SHA | Contact No | 9874558881 |
| Address | 10 T C GOSWAMI STREET | Age | 2 Y 6 M Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 11 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||