Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 03806 | Date 22/02/2019 |
| Token No | SM/18-19/9291 22/02/2019 | Serial | 068 Last Visit: 22/02/2019 |
| Patient Name | Mr. REHAN KOIRESI | Contact No | |
| Address | 14 PARSI LANE SERAMPORE | Age | 10 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 24 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||